掲載種別：研究論文（学術雑誌）   出版者・発行元：SAGE Publications  

Introduction

Sleep disturbances among nurses engaged in night duty and their spouses need to be improved to ensure their ability to provide care and perform daily tasks. Therefore, an objective investigation is needed to establish a sleep improvement strategy.

Objective

To investigate the utility of a sleep tracker to assess sleep quality in nurses and spouses.

Method

Nurses ( n = 30) and spouses ( n = 30) wore a sleep tracker for 14 days to investigate sleep scores. Sleep quality and number of steps were evaluated by Fitbit. They responded to the Richards-Campbell Sleep Questionnaire and Pittsburgh Sleep Quality Index. A multiple regression analysis was performed to identify the factors affecting sleep quality.

Results

Factors affecting sleep scores in nurses were hypnotic medication, night duty, and steps, while those in spouses were mental instability, hypnotic medication, alcohol, night duty, and steps. Factors affecting the Richards-Campbell Sleep Questionnaire in nurses were household chores, night duty, and steps, while those in spouses were hypnotic medication and steps.

Conclusion

The sleep quality of nurses was affected by household chores, hypnotic medication, night duty, and steps. Besides the factors of nurses, spouses were affected by mental instability and alcohol. Night duty affected negativity in both nurses and spouses. Steps exerted positive effects in both the sleep tracker and the Richards-Campbell Sleep Questionnaire. The sleep tracker may be useful for identifying factors that improve sleep quality.

その他リンク： https://journals.sagepub.com/doi/full-xml/10.1177/23779608241267079

DOI： 10.1177/23779608241267079

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掲載種別：研究論文（学術雑誌）   出版者・発行元：SAGE Publications  

Polymyxin B haemoperfusion is commonly used to adsorb endotoxins in septic shock caused by Gram-negative bacterial infections. Polymyxin B haemoperfusion has been reported to improve hypotension in Gram-positive bacterial infections; however, its efficacy and mechanism in treating such cases are unclear. We hypothesised that polymyxin B haemoperfusion would be equally effective in improving haemodynamics during Gram-positive bacterial infections as in Gram-negative bacterial infections. We conducted a retrospective study that included patients with septic shock admitted to the intensive care unit. The patients were divided into two groups according to bacterial culture results: Gram-negative rod (GNR) and Gram-positive coccus (GPC). We calculated the vasoactive inotropic score (VIS) before (0 h) and 2, 6, 12 and 24 h after polymyxin B haemoperfusion therapy. Data were analysed using two-way analysis of variance and post hoc tests for the associations between infection type and treatment time. Overall, 157 patients with septic shock were enrolled in the study: 81 and 76 patients were treated or not treated with extracorporeal haemoperfusion therapy, respectively. Although there was no significant difference in the VIS in polymyxin B haemoperfusion between patients with GNR and GPC infections, there was a significant decrease in the VIS over time, even when GPC was the causative organism. In addition, the degree of reduction in the VIS was significantly different in both the GNR and GPC groups compared with that in the non-extracorporeally treated group. Thus, polymyxin B haemoperfusion for septic shock caused by GNR reduced the VIS and could be effective even in cases of GPC infection.

その他リンク： https://journals.sagepub.com/doi/full-xml/10.1177/0310057X241284300

DOI： 10.1177/0310057x241284300

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掲載種別：研究論文（学術雑誌）   出版者・発行元：Springer Science and Business Media LLC  

Abstract

Background

In recent years, continuous kidney replacement therapy (CKRT) with a cytokine adsorbing hemofilter (CAH) has been used in clinical practice to treat acute kidney injury associated with hypercytokinemia. Two types of CAH are available, including polymethyl methacrylate (PMMA) and polyethylenimine-coated polyacrylonitrile (AN69ST), each having distinct adsorption mechanisms. PMMA adsorbs substances with hydrophobic bases through hydrophobic interactions, resulting in occlusion of the membrane pores. AN69ST adsorbs positively charged substances through electrostatic bonds because its bulk layer is negatively charged. In both CAH, the adsorption efficiency of cytokines with large molecular weights is likely affected by filtration rather than by diffusion transfer. These adsorbing-type membranes have limitations in terms of filtration flow rate because of their low water permeability. The relationship between the adsorption effect and the filtration flow rate in CAH-CKRT has not been fully investigated.

Purpose

The effect of low-convection volume settings below 600 mL/h on cytokine adsorption characteristics was experimentally investigated in CKRT.

Materials and methods

Test solutions, including albumin (4.5%), creatinine (10 mg/dL), interleukin (IL)-6 (1000 pg/mL), and IL-8 (1000 pg/mL), were prepared. The test solution was circulated through the experimental circuit of continuous hemodiafiltration (CHDF) with a total convection volume ranging from 0 to 600 mL/h. The test solution was circulated through the experimental circuit of hemodiafiltration (CHDF) with various dialysate flow rates (QD; 0, 200, 400, and 600 ml/h) and filtration flow rates (QF; 0, 200, 400, and 600 ml/h). Samples immediately before and after CAH from the sampling port of the circuit were collected seven times at 1-min intervals. Clearances of creatinine, IL-6, and IL-8 were calculated for each setting of the proportions of QD and QF during CKRT using PMMA and AN69ST.

Results

Creatinine clearance increased with increasing QD and QF, regardless of the membrane type. There were no significant differences in the adsorption clearance of IL-6 and IL-8 among the different settings, regardless of the membrane type.

Conclusion

The results of this study indicate that the cytokine clearance at a low convection volume in CAH-CKRT was not affected by the filtration flow rate.

その他リンク： https://link.springer.com/article/10.1186/s41100-024-00599-z/fulltext.html

DOI： 10.1186/s41100-024-00599-z

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掲載種別：研究論文（学術雑誌）   出版者・発行元：Wiley  

ABSTRACT

Background

The pathogenesis of sepsis is thought to be linked to a dysregulated immune response, particularly that involving neutrophils. We have developed a granulocyte adsorption column as a “decoy organ,” which relocates the massive inflammation in organs in the body to a blood purification column. This study was conducted to assess the safety and experimental effectiveness of granulocyte monocyte adsorption apheresis‐direct hemoperfusion (G1‐DHP) in the treatment of patients with sepsis, using a prospective, multicenter design.

Methods

The study included patients diagnosed with sepsis and with an APACHE II score ranging from 17 to 34. A total of five G1‐DHP were performed within 3 days of patient enrollment. The primary endpoint was the change in sequential organ failure assessment (SOFA) score from enrollment to 7 days, and the safety endpoints were adverse events and mortality at 28 days.

Results

G1‐DHP was performed on 82 patients. The median (interquartile range) SOFA score decreased from 10 (8–11) to 4 (3–7) after 7 days (n = 70; p < 0.01). Granulocytes, mainly neutrophils, were adsorbed, and the neutrophil‐to‐lymphocyte ratio significantly improved (p < 0.01). Notable improvements were observed in the SOFA scores for circulation and renal function. The acute physiology and chronic health evaluation II score of the 77 patients evaluated for mortality was 27, and the 28‐day mortality rate was 7.8%.

Conclusions

This study confirmed that G1‐DHP can be safely used as an adjunct to standard sepsis treatment regimens. Although further investigations are required, G1‐DHP is a promising supplemental therapy for sepsis.

Trial Registration: jRCT1080225183 (Japan Registry of Clinical Trials identifier)

DOI： 10.1111/aor.14943

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掲載種別：研究論文（学術雑誌）   出版者・発行元：Springer Science and Business Media LLC  

DOI： 10.7759/cureus.77500

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掲載種別：研究論文（学術雑誌）   出版者・発行元：Springer Science and Business Media LLC  

DOI： 10.7759/cureus.76879

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掲載種別：研究論文（学術雑誌）   出版者・発行元：Springer Science and Business Media LLC  

その他リンク： https://link.springer.com/article/10.1007/s44337-024-00120-9/fulltext.html

DOI： 10.1007/s44337-024-00120-9

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掲載種別：研究論文（学術雑誌）   出版者・発行元：Springer Science and Business Media LLC  

DOI： 10.7759/cureus.71555

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掲載種別：研究論文（学術雑誌）   出版者・発行元：Springer Science and Business Media LLC  

DOI： 10.7759/cureus.71029

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掲載種別：研究論文（学術雑誌）   出版者・発行元：Springer Science and Business Media LLC  

その他リンク： https://link.springer.com/article/10.1007/s12149-024-01975-9/fulltext.html

DOI： 10.1007/s12149-024-01975-9

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掲載種別：研究論文（学術雑誌）   出版者・発行元：Springer Science and Business Media LLC  

DOI： 10.7759/cureus.66834

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掲載種別：研究論文（学術雑誌）   出版者・発行元：Springer Science and Business Media LLC  

DOI： 10.7759/cureus.63103

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掲載種別：研究論文（学術雑誌）   出版者・発行元：MDPI AG  

Background: The utility of using indirect calorimetry (IC) to estimate energy needs and methods for its application to this purpose remain unclear. This systematic review investigated whether using IC to estimate energy expenditure in critically ill patients is more meaningful for improving survival than other estimation methods. Methods: Comprehensive searches were conducted in MEDLINE using PubMed, Cochrane Central Register of Controlled Trials, and Igaku-Chuo-Zasshi up to March 2023. Results: Nine RCTs involving 1178 patients were included in the meta-analysis. The evidence obtained suggested that energy delivery by IC improved short-term mortality (risk ratio, 0.86; 95% confidence interval [CI], 0.70 to 1.06). However, the use of IC did not appear to affect the length of ICU stay (mean difference [MD], 0.86; 95% CI, −0.98 to 2.70) or the duration of mechanical ventilation (MD, 0.66; 95% CI, −0.39 to 1.72). Post hoc analyses using short-term mortality as the outcome found no significant difference by target calories in resting energy expenditure, whereas more frequent IC estimates were associated with lower short-term mortality and were more effective in mechanically ventilated patients. Conclusions: This updated meta-analysis revealed that the use of IC may improve short-term mortality in patients with critical illness and did not increase adverse events.

DOI： 10.3390/nu16101452

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掲載種別：研究論文（学術雑誌）   出版者・発行元：MDPI AG  

The effectiveness of rehabilitation programs (RP) for chronic obstructive pulmonary disease (COPD) exacerbation remains controversial. However, few studies have investigated the combined effects of exercise and nutritional therapy. This study aimed to determine the effects of combined nutritional therapy on the physical function and nutritional status of patients with COPD exacerbation who underwent early RP. A randomized controlled trial was conducted in patients hospitalized for COPD exacerbations. Patients were assigned to receive a regular diet in addition to RP (control group) or RP and nutrition therapy (intervention group). Physical function, including quadricep strength and body composition, was assessed. The intervention group was administered protein-rich oral nutritional supplements. A total of 38 patients with negligible baseline differences were included in the analysis. The intervention group showed a notably greater change in quadriceps strength. Lean body mass and skeletal muscle indices markedly decreased in the control group but were maintained in the intervention group. Logistic regression analysis identified nutritional therapy as a significant factor associated with increased muscle strength. No serious adverse events were observed in either group. Therefore, nutritional therapy combined with RP is safe and effective for improving exercise function while maintaining body composition in patients with COPD exacerbation.

DOI： 10.3390/nu16050739

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掲載種別：研究論文（学術雑誌）   出版者・発行元：Frontiers Media SA  

Background

In-hospital cardiac arrest (IHCA) is a critical medical event with outcomes less researched compared to out-of-hospital cardiac arrest. This retrospective observational study aimed to investigate key aspects of IHCA epidemiology and prognosis in patients with Code Blue activation.

Methods

This retrospective observational study enrolled patients with Code Blue events in our hospital between January 2010 and October 2019. Participant characteristics, including age and sex, and IHCA characteristics, including the time of cardiac arrest, witnessed event, bystander cardiopulmonary resuscitation (CPR), initial shockable rhythm, vital signs at 1 and 6 h before IHCA, survival to hospital discharge (SHD), and the cardiac arrest survival postresuscitation in-hospital (CASPRI) score were included in univariate and multivariate logistic regression analyses with SHD as the primary endpoint.

Results

From the 293 Code Blue events that were activated during the study period, 81 participants were enrolled. Overall, the SHD rate was 28.4%, the median CPR duration was 14 (interquartile range, 6–28) min, and the rate of initial shockable rhythm was 19.8%. There were significant intergroup differences between the SHD and non-SHD groups in the CPR duration, shockable rhythm, and CASPRI score on univariate logistic regression analysis. Multivariate logistic regression analysis showed that the CASPRI score was the most accurate predictive factor for SHD (OR = 0.98, p = 0.006).

Conclusions

The CASPRI score is associated with SHD in patients with IHCA during Code Blue events. Therefore, the CASPRI score of IHCA patients potentially constitutes a simple, useful adjunctive tool for the management of post-cardiac arrest syndrome.

DOI： 10.3389/fcvm.2023.1247340

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掲載種別：研究論文（学術雑誌）   出版者・発行元：S. Karger AG  

<b><i>Introduction:</i></b> Patients with exacerbated chronic obstructive pulmonary disease (COPD) have a reduced ability to perform activities of daily living (ADLs). Rehabilitation programs (RPs) and nutritional therapy may affect the ability to perform ADLs. <b><i>Objective:</i></b> The objective of the study was to clarify the factors associated with reduced ability to perform ADLs in patients with COPD exacerbation. <b><i>Subjects/Methods:</i></b> A multivariate analysis of 75 patients (mean age, 77 years) with COPD exacerbation, divided into the Barthel index (BI) decline (△BI decreased ≥15) and without BI decline (△BI decreased ≤10) groups, was performed. Patient characteristics, duration before RP initiation, functional variables, and nutrition-related variables were compared between the groups. <b><i>Results:</i></b> The degree of dyspnea and serum albumin levels before and at RP initiation were significantly lower in the BI decline group. The Hoffer classification score and duration between hospital admission and RP initiation were significantly higher and longer, respectively, in the BI decline group. The duration between hospital admission and RP initiation and dietary intake at RP initiation were independent predictors of reduced ability to perform ADLs. <b><i>Conclusions:</i></b> Early RP initiation and aggressive nutritional therapy may mitigate the risk of reduced ability to perform ADLs, thus decreasing dependence and disability in patients with COPD exacerbation.

DOI： 10.1159/000534697

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掲載種別：研究論文（学術雑誌）   出版者・発行元：Public Library of Science (PLoS)  

Introduction

Linezolid (LZD) is one of the antibiotics used to treat methicillin-resistant Staphylococcus aureus. In Japan, the dose of LZD is not generally adjusted by renal function or therapeutic drug monitoring and is readily available for critically ill patients. The adverse effects of LZD include pancytopenia, especially thrombocytopenia. We investigated the effect of LZD on platelet counts in critically ill patients with thrombocytopenia during admission to the intensive care unit (ICU).

Methods

Fifty-five critically ill patients with existing thrombocytopenia (platelet count < 100 ×10³ /μL) who received LZD for five days or more during the period from January 2011 to October 2018 were included. Changes in platelet count and frequency of platelet concentrate (PC) transfusion were evaluated retrospectively.

Results

Mean (± standard error) platelet count prior to initiation of LZD was 47 ± 4 ×10³ /uL, which increased significantly to 86 ± 13 ×10³ /uL on day 15 (p<0.01). Median [interquartile range] duration of LZD therapy was 9 [8–12] days. Thirty-two patients (58.2%) required PC transfusion in the 15-day study period. The daily rate of PC transfusion decreased from 30.2% on days 1–5 to 18.2% on days 11–15. Similar tendencies were observed in patients with non-hematological and hematological disease.

Conclusion

Thrombocytopenia in critically ill patients in the ICU did not worsen after initiation of LZD therapy, and may be considered for the treatment of MRSA in this setting.

DOI： 10.1371/journal.pone.0286088

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

その他リンク： https://onlinelibrary.wiley.com/doi/full-xml/10.1111/nicc.12880

DOI： 10.1111/nicc.12880

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掲載種別：研究論文（学術雑誌）   出版者・発行元：Springer Science and Business Media LLC  

Abstract

Background

The Japan Society for Blood Purification in Critical Care (JSBPCC) has reported survey results on blood purification therapy (BPT) for critically ill patients in 2005, 2009, and 2013. To clarify the current clinical status, including details of the modes used, treated diseases, and survival rate, we conducted this cohort study using data from the nationwide JSBPCC registry in 2018.

Methods

We analyzed data of 2371 patients who underwent BPT in the intensive care units of 43 facilities to investigate patient characteristics, disease severity, modes of BPTs, including the dose of continuous renal replacement therapy (CRRT) and hemofilters, treated diseases, and the survival rate for each disease. Disease severity was assessed using Acute Physiology and Chronic Health Evaluation (APACHE) II and Sequential Organ Failure Assessment (SOFA) scores.

Results

BPT was performed 2867 times in the 2371 patients. Mean APACHE II and SOFA scores were 23.5 ± 9.4 and 10.0 ± 4.4, respectively. The most frequently used mode of BPT was CRRT (67.4%), followed by intermittent renal replacement therapy (19.1%) and direct hemoperfusion with the polymyxin B-immobilized fiber column (7.3%). The most commonly used anticoagulant was nafamostat mesilate (78.6%). Among all patients, the 28-day survival rate was 61.7%. CRRT was the most commonly used mode for many diseases, including acute kidney injury (AKI), multiple organ failure (MOF), and sepsis. The survival rate decreased according to the severity of AKI (P = 0.001). The survival rate was significantly lower in patients with multiple organ failure (MOF) (34.6%) compared with acute lung injury (ALI) (48.0%) and sepsis (58.0%). Multivariate logistic regression analysis revealed that sepsis, ALI, acute liver failure, cardiovascular hypotension, central nervous system disorders, and higher APACHE II scores were significant predictors of higher 28-day mortality.

Conclusion

This large-scale cohort study revealed the current status of BPT in Japan. It was found that CRRT was the most frequently used mode for critically ill patients in Japan and that 28-day survival was lower in those with MOF or sepsis. Further investigations are required to clarify the efficacy of BPT for critically ill patients.

Trial Registration: UMIN000027678.

その他リンク： https://link.springer.com/article/10.1186/s41100-022-00445-0/fulltext.html

DOI： 10.1186/s41100-022-00445-0

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：MDPI AG  

Background and Objectives: The main objective of a transitional care program (TCP) is to detect patients with early deterioration following intensive care unit (ICU) discharge in order to reduce unplanned ICU readmissions. Consensus on the effectiveness of TCPs in preventing unscheduled ICU readmissions remains lacking. In this case study assessing the effectiveness of TCP, we focused on the association of unplanned ICU readmission with high nursing activities scores (NASs), which are considered a risk factor for ICU readmission. Materials and Methods: This retrospective observational study analyzed the data of patients admitted to a single-center ICU between January 2016 and December 2019, with an NAS of >53 points at ICU discharge. The following data were extracted: patient characteristics, ICU treatment, acute physiology and chronic health evaluation II (APACHE II) score at ICU admission, Charlson comorbidity index (CCI), 28-day mortality rate, and ICU readmission rate. The primary outcome was the association between unplanned ICU readmissions and the use of a TCP. The propensity score (PS) was calculated using the following variables: age, sex, APACHE II score, and CCI. Subsequently, logistic regression analysis was performed using the PS to evaluate the outcomes. Results: A total of 143 patients were included in this study, of which 87 (60.8%) participated in a TCP. Respiratory failure was the most common cause of unplanned ICU readmission. The unplanned ICU readmission rate was significantly lower in the TCP group. In the logistic regression model, TCP (odds ratio, 5.15; 95% confidence interval, 1.46-18.2; p = 0.01) was independently associated with unplanned ICU readmission. Conclusions: TCP intervention with a focus on patients with a high NAS (>53 points) may prevent unplanned ICU readmission.

DOI： 10.3390/medicina58111532

PubMed

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：MDPI AG  

This study evaluated the accuracy of predicting unplanned the intensive care unit (ICU) readmission using the Nursing Activities Score (NAS) at ICU discharge based on nursing workloads, and compared it to the accuracy of the prediction made using the Stability and Workload Index for Transfer (SWIFT) score. Patients admitted to the ICU of Sapporo Medical University Hospital between April 2014 and December 2017 were included, and unplanned ICU readmissions were retrospectively evaluated using the SWIFT score and the NAS. Patient characteristics, such as age, sex, the Charlson Comorbidity Index, and sequential organ failure assessment score at ICU admission, were used as covariates, and logistic regression analysis was performed to calculate the odds ratios for the SWIFT score and NAS. Among 599 patients, 58 (9.7%) were unexpectedly readmitted to the ICU. The area under the receiver operating characteristic curve of NAS (0.78) was higher than that of the SWIFT score (0.68), and cutoff values were 21 for the SWIFT and 53 for the NAS. Multivariate analysis showed that the NAS was an independent predictor of unplanned ICU readmission. The NAS was superior to the SWIFT in predicting unplanned ICU readmission. NAS may be an adjunctive tool to predict unplanned ICU readmission.

DOI： 10.3390/jcm11175203

PubMed

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

DOI： 10.3748/wjg.v28.i31.4442

PubMed

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掲載種別：研究論文（学術雑誌）   出版者・発行元：Elsevier BV  

DOI： 10.1016/j.clinthera.2021.12.008

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：Springer Science and Business Media LLC  

BACKGROUND: Extubation failure, i.e., reintubation in ventilated patients, is a well-known risk factor for mortality and prolonged stay in the intensive care unit (ICU). Although sputum volume is a risk factor, the frequency of tracheal suctioning has not been validated as a predictor of reintubation. We conducted this study to examine whether frequent tracheal suctioning is a risk factor for reintubation. PATIENTS AND METHODS: We included adult patients who were intubated for > 72 h in the ICU and extubated after completion of spontaneous breathing trial (SBT). We compared the characteristics and weaning-related variables, including the frequency of tracheal suctioning between patients who required reintubation within 24 h after extubation and those who did not, and examined the factors responsible for reintubation. RESULTS: Of the 400 patients enrolled, reintubation was required in 51 (12.8%). The most common cause of reintubation was difficulty in sputum excretion (66.7%). There were significant differences in sex, proportion of patients with chronic kidney disease, pneumonia, ICU admission type, the length of mechanical ventilation, and ICU stay between patients requiring reintubation and those who did not. Multivariate analysis showed frequent tracheal suction (> once every 2 h) and the length of mechanical ventilation were independent factors for predicting reintubation. CONCLUSION: We should examine the frequency of tracheal suctioning > once every 2 h in addition to the length of mechanical ventilation before deciding to extubate after completion of SBT in patients intubated for > 72 h in the ICU.

その他リンク： https://link.springer.com/article/10.1186/s40981-022-00495-7/fulltext.html

DOI： 10.1186/s40981-022-00495-7

PubMed

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掲載種別：研究論文（学術雑誌）   出版者・発行元：SAGE Publications  

Introduction

The efficacy of antithrombin (AT) supplementation against septic disseminated intravascular coagulation (DIC) may depend on various pre-existing factors, particularly the AT dose and multiple organ dysfunction severity. This study aimed to identify the impactful factors for early DIC recovery.

Methods

Patients’ clinical records, including AT therapy and septic DIC data, were retrospectively extracted from January 2015 to December 2020. The patients were divided into those with early DIC recovery (n = 34) and those without (n = 37). Multivariate logistic regression analysis determined significant independent factors. Time-to-event analysis confirmed how these factors affected the DIC recovery time.

Results

The AT dose per patient body weight (odds ratio [95% confidence interval]: 2.879 [1.031-8.042], P = 0.044) and pre-existing organ dysfunction severity (0.333 [0.120-0.920], P = 0.034) were significant independent factors affecting early DIC recovery. A higher AT dose significantly shortened the DIC recovery time among patients with severe organ dysfunction ( P < 0.01), but not among non-severe patients ( P = 0.855).

Conclusion

The therapeutic efficacy of AT treatment for septic DIC might depend on the severity of pre-existing organ failure and the AT dose per patient body weight.

その他リンク： https://journals.sagepub.com/doi/full-xml/10.1177/10760296221080942

DOI： 10.1177/10760296221080942

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記述言語：日本語   出版者・発行元：日本救命医療学会  

医中誌

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掲載種別：研究論文（学術雑誌）  

DOI： 10.13105/wjma.v9.i5.462

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：Walter de Gruyter GmbH  

INTRODUCTION: The medical emergency team enables the limitation of patients' progression to critical illness in the general ward. The early warning scoring system (EWS) is one of the criteria for medical emergency team activation; however, it is not a valid criterion to predict the prognosis of patients with MET activation. AIM: In this study, the National Early Warning Score (NEWS) and Rapid Emergency Medicine Score (REMS) was compared with that of the Acute Physiology and Chronic Health Evaluation II (APACHE II) score in predicting the prognosis of patients who had been treated a medical emergency team. MATERIAL AND METHODS: In this single-centre retrospective cohort study, patients treated by a medical emergency team between April 2013 and March 2019 and the 28-day prognosis of MET-activated patients were assessed using APACHE II, NEWS, and REMS. RESULTS: Of the 196 patients enrolled, 152 (77.5%) were men, and 44 (22.5%) were women. Their median age was 68 years (interquartile range: 57-76 years). The most common cause of medical emergency team activation was respiratory failure (43.4%). Univariate analysis showed that APACHE II score, NEWS, and REMS were associated with 28-day prognostic mortality. There was no significant difference in the area under the receiver operating characteristic curve of APACHE II (0.76), NEWS (0.67), and REMS (0.70); however, the sensitivity of NEWS (0.70) was superior to that of REMS (0.47). CONCLUSION: NEWS is a more sensitive screening tool like APACHE II than REMS for predicting the prognosis of patients with medical emergency team activation. However, because the accuracy of NEWS was not sufficient compared with that of APACHE II score, it is necessary to develop a screening tool with higher sensitivity and accuracy that can be easily calculated at the bedside in the general ward.

DOI： 10.2478/jccm-2021-0040

PubMed

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掲載種別：研究論文（学術雑誌）   出版者・発行元：BMJ  

DOI： 10.1136/bcr-2021-246068

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掲載種別：研究論文（学術雑誌）   出版者・発行元：Springer Science and Business Media LLC  

Abstract

The Japanese Clinical Practice Guidelines for Management of Sepsis and Septic Shock 2020 (J-SSCG 2020), a Japanese-specific set of clinical practice guidelines for sepsis and septic shock created as revised from J-SSCG 2016 jointly by the Japanese Society of Intensive Care Medicine and the Japanese Association for Acute Medicine, was first released in September 2020 and published in February 2021. An English-language version of these guidelines was created based on the contents of the original Japanese-language version. The purpose of this guideline is to assist medical staff in making appropriate decisions to improve the prognosis of patients undergoing treatment for sepsis and septic shock. We aimed to provide high-quality guidelines that are easy to use and understand for specialists, general clinicians, and multidisciplinary medical professionals. J-SSCG 2016 took up new subjects that were not present in SSCG 2016 (e.g., ICU-acquired weakness [ICU-AW], post-intensive care syndrome [PICS], and body temperature management). The J-SSCG 2020 covered a total of 22 areas with four additional new areas (patient- and family-centered care, sepsis treatment system, neuro-intensive treatment, and stress ulcers). A total of 118 important clinical issues (clinical questions, CQs) were extracted regardless of the presence or absence of evidence. These CQs also include those that have been given particular focus within Japan. This is a large-scale guideline covering multiple fields; thus, in addition to the 25 committee members, we had the participation and support of a total of 226 members who are professionals (physicians, nurses, physiotherapists, clinical engineers, and pharmacists) and medical workers with a history of sepsis or critical illness. The GRADE method was adopted for making recommendations, and the modified Delphi method was used to determine recommendations by voting from all committee members.

As a result, 79 GRADE-based recommendations, 5 Good Practice Statements (GPS), 18 expert consensuses, 27 answers to background questions (BQs), and summaries of definitions and diagnosis of sepsis were created as responses to 118 CQs. We also incorporated visual information for each CQ according to the time course of treatment, and we will also distribute this as an app. The J-SSCG 2020 is expected to be widely used as a useful bedside guideline in the field of sepsis treatment both in Japan and overseas involving multiple disciplines.

その他リンク： https://link.springer.com/article/10.1186/s40560-021-00555-7/fulltext.html

DOI： 10.1186/s40560-021-00555-7

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掲載種別：研究論文（学術雑誌）   出版者・発行元：Elsevier BV  

DOI： 10.1016/j.jmii.2020.08.013

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掲載種別：研究論文（学術雑誌）   出版者・発行元：International Scientific Information, Inc.  

DOI： 10.12659/ajcr.930568

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掲載種別：研究論文（学術雑誌）   出版者・発行元：Biomedical Research Network, LLC  

DOI： 10.26717/bjstr.2021.34.005541

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掲載種別：研究論文（学術雑誌）   出版者・発行元：Elsevier BV  

DOI： 10.1016/j.nut.2020.111093

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掲載種別：研究論文（学術雑誌）  

DOI： 10.13105/wjma.v9.i1.88

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：SAGE Publications  

Visitation restrictions for family members are problematic in intensive care management due to the COVID-19 pandemic. We analyzed the usefulness of an intensive care unit (ICU) diary about the experiences of family members of critical COVID-19 patients. Four family members of 2 COVID-19 patients participated in this report. Both patients were transferred to our ICU after 2 weeks of treatment at another ICU. An ICU diary was given to their family members post-transfer. The family members were interviewed before and after the patients' discharge; the recorded interviews were analyzed and categorized into several clusters using a text mining method. Five categories regarding their anxious feelings were classified before the use of the ICU diary, and 3 categories were based on their positive feelings after the use of the ICU diary. Intensive care unit diaries may be beneficial for disclosing patients' information when visitation restrictions are exercised due to the COVID-19 pandemic.

その他リンク： https://journals.sagepub.com/doi/full-xml/10.1177/23743735211034094

DOI： 10.1177/23743735211034094

PubMed

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掲載種別：研究論文（学術雑誌）   出版者・発行元：Springer Science and Business Media LLC  

Abstract

Background

Clinical evidence showing the effectiveness of recombinant human soluble thrombomodulin (rhTM) for treating sepsis-induced disseminated intravascular coagulation (DIC) and organ dysfunction (particularly renal injury) is limited because of differences in the inclusion criteria and disease severity among patients. This study aimed to assess the association between rhTM and outcomes in septic DIC patients with acute kidney injury (AKI).

Methods

This retrospective observational study analyzed the data of patients who were admitted to the intensive care unit (ICU) of a single center between January 2012 and December 2018, and diagnosed with sepsis-induced DIC and AKI. Data were extracted as follows: patients’ characteristics; DIC score, as calculated by the Japanese Association for Acute Medicine and the International Society of Thrombosis and Hemostasis criteria; serum creatinine levels; and ICU and 28-day mortality rates. The primary outcome was the dependence on renal replacement therapy (RRT) at ICU discharge. The propensity score (PS) was calculated using the following variables: age, sex, septic shock at admission, DIC score, and KDIGO classification. Subsequently, logistic regression analysis was performed using the PS to evaluate the outcome.

Results

In total, 97 patients were included in this study. Of these, 52 (53.6%) patients had received rhTM. The dependence on RRT at ICU discharge was significantly lower in the rhTM than in the non-rhTM group (odds ratio [OR], 0.43; 95% confidence interval [CI], 0.19–0.97; P = 0.043). The serum creatinine levels at ICU discharge (OR, 0.31; 95% CI, 0.13–0.72; P = 0.007) and hospital discharge (OR, 0.25; 95% CI, 0.11–0.60; P = 0.002, respectively), and the 28-day mortality rate (OR, 0.40; 95% CI, 0.17–0.93; P = 0.033) were significantly lower in the rhTM than in the non-rhTM group. Moreover, the Kaplan–Meier survival curve revealed significantly lower mortality rates in the rhTM than in the non-rhTM group (P = 0.009). No significant differences in the DIC score and AKI severity were observed between the groups.

Conclusions

Among sepsis-induced DIC patients with AKI, rhTM administration was associated with lower dependence on RRT at ICU discharge, improvement in renal function, and lower 28-day mortality rate.

その他リンク： http://link.springer.com/article/10.1186/s40560-020-00512-w/fulltext.html

DOI： 10.1186/s40560-020-00512-w

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掲載種別：研究論文（学術雑誌）   出版者・発行元：Public Library of Science (PLoS)  

DOI： 10.1371/journal.pone.0228093

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掲載種別：研究論文（学術雑誌）   出版者・発行元：Walter de Gruyter GmbH  

Abstract

Introduction

In Acute Respiratory Distress Syndrome (ARDS), the heterogeneity of lung lesions results in a mis-match between ventilation and perfusion, leading to the development of hypoxia. The study aimed to examine the association between computed tomographic (CT scan) lung findings in patients with ARDS after abdominal surgery and improved hypoxia and mortality after prone ventilation.

Material and Methods

A single site, retrospective observational study was performed at the Sapporo Medical University School of Medicine, Sapporo, Hokkaido, Japan, between 1st January 2004 and 31st October 2018. Patients were allocated to one of two groups after CT scanning according to the presence of ground-glass opacity (GGO) or alveolar shadow with predominantly dorsal lung atelectasis (DLA) on lung CT scan images. Also, Patients were divided into a prone ventilation group and a supine ventilation group when the treatment for ARDS was started.

Results

We analyzed data for fifty-one patients with ARDS following abdominal surgery. CT scans confirmed GGO in five patients in the Group A and in nine patients in the Group B, and DLA in 17 patients in the Group A and nine patients in the Group B. Both GGO and DLA were present in two patients in the Group A and nine patients in the Group B. Prone ventilation significantly improved patients’ impaired ratio of arterial partial pressure of oxygen to fraction of inspired oxygen from 12 h after prone positioning compared with that in the supine position. Weaning from mechanical ventilation occurred significantly earlier in the Group A with DLA vs the Group B with DLA (P < 0.001). Twenty-eight-day mortality was significantly lower for the Group A with DLA vs the Group B with DLA (P = 0.035).

Conclusions

These results suggest that prone ventilation could be effective for treating patients with ARDS as showing the DLA.

その他リンク： https://www.sciendo.com/pdf/10.2478/jccm-2020-0003

DOI： 10.2478/jccm-2020-0003

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掲載種別：研究論文（学術雑誌）   出版者・発行元：Wiley  

Aim

The aim of the present study was to investigate the effects of individualized nutritional treatment on the activities of daily living of acute stroke patients.

Methods

This was a randomized controlled study. The eligibility criteria were acute stroke, age >65 years and the presence of malnutrition risk. Between September 2016 and December 2017, 128 patients were assigned to either the standard or intensive group (individualized nutritional treatment). The intensive group received energy that was calculated using the Harris–Benedict equation. The main outcome measures were the total functional independence measurement gain from the time of assignment to the time of discharge from the recovery hospital or at 3 months after the stroke onset, and motor and cognitive functional independence measurement gains.

Results

Compared with the standard group, the intensive group had significantly higher median energy intake (P < 0.001); significantly greater functional independence measurement gains in the total score (42 vs. 22; P = 0.02) and motor subscore (P = 0.01), but similar cognitive subscore.

Conclusion

Individualized nutritional treatment improved the activities of daily living of older acute stroke patients with malnutrition risk. Geriatr Gerontol Int 2019; ••: ••–••.

その他リンク： https://onlinelibrary.wiley.com/doi/full-xml/10.1111/ggi.13854

DOI： 10.1111/ggi.13854

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掲載種別：研究論文（学術雑誌）   出版者・発行元：S. Karger AG  

<b><i>Background and Oblectives:</i></b> We evaluated the success rate of endoscopically positioned nasojejunal feeding tubes and the intragastric countercurrent of contrast medium thereafter. <b><i>Method:</i></b> This retrospective observational study investigated patients who were admitted to a single intensive care unit and required endoscopic placement of a post-pyloric feeding tube between January 2010 and June 2016. The feeding tube was grasped with forceps via a transoral endoscope and inserted into the duodenum or jejunum. Thereafter, we assessed the position of the tube and the intragastric countercurrent using abdominal radiography with contrast medium. <b><i>Results:</i></b> The tube tip was inserted at the jejunum and the duodenal fourth portion in 55.8 and 33.6% of patients, respectively. The tip of the inserted tube had moved into the jejunum of 71.7% of patients by the following day. The countercurrent rate was significantly lower among patients with a tube inserted into the duodenal fourth portion or more distal than among those with tubes inserted more proximally (8.4 vs. 45.4%, <i>p</i> = 0.0022). <b><i>Conclusions:</i></b> The endoscopic insertion and positioning of a nasojejunal feeding tube seemed effective because the rate of tube insertion into the duodenal fourth portion or more distal was about 90%. The findings of intragastric countercurrents indicated that feeding tubes should be inserted into the duodenal fourth portion or beyond to prevent vomiting and the aspiration of enteral nutrients.

DOI： 10.1159/000502676

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掲載種別：研究論文（学術雑誌）   出版者・発行元：Springer Science and Business Media LLC  

その他リンク： http://link.springer.com/article/10.1186/s40560-019-0378-0/fulltext.html

DOI： 10.1186/s40560-019-0378-0

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掲載種別：研究論文（学術雑誌）   出版者・発行元：Springer Science and Business Media LLC  

その他リンク： http://link.springer.com/article/10.1186/s41100-018-0196-1/fulltext.html

DOI： 10.1186/s41100-018-0196-1

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掲載種別：研究論文（学術雑誌）   出版者・発行元：S. Karger AG  

<b><i>Background:</i></b> There is lack of evidence regarding nutritional management among intensive care unit (ICU) patients in a population with relatively low body mass index. Therefore, we conducted an observational study to assess the nutritional management in Japanese ICUs. Also, we investigated the impact of nutritional management and rehabilitation on physical outcome. <b><i>Methods:</i></b> The study population comprised 389 consecutive patients who received mechanical ventilation for at least 24 h and those admitted to the ICU for > 72 h in 13 hospitals. The primary outcomes were caloric and protein intake in ICU on days 3 and 7, and at ICU discharge. The secondary outcome was the impact of nutritional management and rehabilitation on physical status at ICU discharge. We defined good physical status as more than end sitting and poor physical status as bed rest and sitting. We divided the participants into 2 groups, namely, the good physical status group (Good group) and poor physical status group (Poor group) for analysis of the secondary outcome. Data were expressed as median (interquartile range). <b><i>Results:</i></b> The median amount of caloric intake on days 3 and 7, and at ICU discharge via enteral and parenteral routes were 8.4 (3.1–15.6), 14.9 (7.5–22.0), and 11.2 (2.5–19.1) kcal/kg/day, respectively. The median amount of protein intake on days 3 and 7, and at ICU discharge were 0.2 (0–0.5), 0.4 (0.1–0.8), and 0.3 (0–0.7) g/kg/day, respectively. The amount of caloric intake on day 3 in the Poor group was significantly higher than that of the Good group (10.1 [5.8, 16.2] vs. 5.2 [1.9, 12.4] kcal/kg/day, <i>p</i> < 0.001). The proportion of patients who were received rehabilitation in ICU in the Good group was significantly higher than that of the Poor group (92 vs. 63%, <i>p</i> < 0.001). The multivariate analysis revealed that caloric intake on day 3 and rehabilitation in ICU were considered independent factors that affect physical status (OR 1.19; 95% CI 1.05–1.34; <i>p</i> = 0.005 and OR 0.07; 95% CI 0.01–0.34; <i>p</i> = 0.001). <b><i>Conclusions:</i></b> The caloric and protein intakes in Japanese ICUs were 15 kcal/kg/day and 0.4 g/kg/day, respectively. In addition, critically ill patients might benefit from low caloric intake (less than 10 kcal/kg/day) until day 3 and rehabilitation during ICU stay.

DOI： 10.1159/000495213

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掲載種別：研究論文（学術雑誌）   出版者・発行元：SAGE Publications  

Objective:

We investigated the differences in biocompatibility pre- and post-dilution during continuous veno-venous hemofiltration in patients with sepsis, focusing on leukocyte and platelet function.

Patients and methods:

Subjects were 12 patients with septic shock who underwent veno-venous hemofiltration for acute kidney injury between March 2016 and September 2017. The first six patients received pre-dilution veno-venous hemofiltration, and the next six patients received post-dilution veno-venous hemofiltration. The blood flow rate and filtration flow rate for veno-venous hemofiltration using a polysulfone hemofilter were set to 150 and 35 mL/min, respectively. Leukocyte and platelet counts were determined at 0 and 24 h after veno-venous hemofiltration commencement. Serum interleukin-6 and interleukin-10 levels, the induction rates of regulatory T cells, the expression rate of monocyte HLA-DR, neutrophil phagocytic and sterilizing ability, and platelet P-selectin expression rate were determined at 0, 6, and 24 h after veno-venous hemofiltration commencement.

Results:

There were no significant differences in patient characteristics between the two groups. Serum interleukin-6 decreased over time during pre- and post-dilution veno-venous hemofiltration. Serum interleukin-10 levels decreased during pre-dilution veno-venous hemofiltration, but remained unchanged during post-dilution veno-venous hemofiltration. The Treg and platelet P-selectin expression rates significantly increased at 24 h compared to 0 h during post-dilution veno-venous hemofiltration. Neutrophil phagocytic ability at 24 h was significantly decreased compared to that at 0 h during post-dilution veno-venous hemofiltration. No significant changes in leukocyte and platelet function were observed during pre-dilution veno-venous hemofiltration.

Conclusion:

Pre-dilution veno-venous hemofiltration demonstrates superior biocompatibility in terms of decreased leukocyte function and platelet activation in septic shock patients with acute kidney injury.

その他リンク： https://journals.sagepub.com/doi/full-xml/10.1177/0391398818801292

DOI： 10.1177/0391398818801292

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掲載種別：研究論文（学術雑誌）   出版者・発行元：Wiley  

Background and Purpose

The Japanese Clinical Practice Guidelines for Management of Sepsis and Septic Shock 2016 (J‐SSCG2016), a Japanese‐specific set of clinical practice guidelines for sepsis and septic shock created jointly by the Japanese Society of Intensive Care Medicine and the Japanese Association for Acute Medicine, was first released in February 2017 in Japanese. An English‐language version of these guidelines was created based on the contents of the original Japanese‐language version.

Methods

Members of the Japanese Society of Intensive Care Medicine and the Japanese Association for Acute Medicine were selected and organized into 19 committee members and 52 working group members. The guidelines were prepared in accordance with the Medical Information Network Distribution Service (Minds) creation procedures. The Academic Guidelines Promotion Team was organized to oversee and provide academic support to the respective activities allocated to each Guideline Creation Team. To improve quality assurance and workflow transparency, a mutual peer review system was established, and discussions within each team were open to the public. Public comments were collected once after the initial formulation of a clinical question (CQ), and twice during the review of the final draft. Recommendations were determined to have been adopted after obtaining support from a two‐thirds (>66.6%) majority vote of each of the 19 committee members.

Results

A total of 87CQs were selected among 19 clinical areas, including pediatric topics and several other important areas not covered in the first edition of the Japanese guidelines (J‐SSCG2012). The approval rate obtained through committee voting, in addition to ratings of the strengths of the recommendation and its supporting evidence were also added to each recommendation statement. We conducted meta‐analyses for 29CQs. Thirty sevenCQs contained recommendations in the form of an expert consensus due to insufficient evidence. No recommendations were provided for 5CQs.

Conclusions

Based on the evidence gathered, we were able to formulate Japanese‐specific clinical practice guidelines that are tailored to the Japanese context in a highly transparent manner. These guidelines can easily be used not only by specialists, but also by non‐specialists, general clinicians, nurses, pharmacists, clinical engineers, and other healthcare professionals.

DOI： 10.1002/ams2.322

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掲載種別：研究論文（学術雑誌）   出版者・発行元：Springer Science and Business Media LLC  

その他リンク： https://link.springer.com/article/10.1007/s10047-016-0922-9/fulltext.html

DOI： 10.1007/s10047-016-0922-9

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

その他リンク： http://link.springer.com/article/10.1007/s00540-013-1751-0/fulltext.html

DOI： 10.1007/s00540-013-1751-0

Web of Science

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：S. Karger AG  

DOI： 10.1159/000368714

PubMed

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

DOI： 10.1002/jhbp.87

Web of Science

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掲載種別：研究論文（学術雑誌）   出版者・発行元：Springer Science and Business Media LLC  

その他リンク： https://link.springer.com/article/10.1007/s10047-013-0742-0/fulltext.html

DOI： 10.1007/s10047-013-0742-0

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

DOI： 10.1016/j.surg.2013.04.039

Web of Science

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掲載種別：研究論文（学術雑誌）   出版者・発行元：SAGE Publications  

This study evaluated the usefulness of asialoglycoprotein receptor scintigraphy with ^99mTc-galactosyl human serum albumin (^99mTc-GSA scintigraphy) as an early predictor for prognosis of acute liver failure. Forty-eight patients with acute liver failure and without a past history of chronic liver disease were enrolled. Patients were divided into survival and non-survival groups by 28-day mortality. ^99mTc-GSA scintigraphy to detect uptake ratio of the heart at 15 minutes to that at three minutes (HH₁₅) and uptake ratio of the liver at 15 minutes to the liver plus the heart at 15 minutes (LHL₁₅), and measurements of serum total bilirubin, hepatocyte growth factor and prothrombin time were performed immediately after the diagnosis of acute liver failure. Areas under the receiver operating characteristic curves were used to compare the prognostic ability of total bilirubin, hepatocyte growth factor, prothrombin time, HH₁₅ ratio, LHL₁₅ ratio and the model for end-stage liver disease score. Clinical characteristics of patients in the survival group (n=20) and in the non-survival group (n=28) were not significantly different. HH₁₅ and LHL₁₅ uptake ratios in the survival group were 0.670 and 0.875, and they were significantly lower and higher than those in the non-survival group, respectively. All patients with LHL₁₅ <0.760 died, and the area under the receiver operating characteristic curve for LHL₁₅ were significantly larger than the areas under the receiver operating characteristic curves of serum variables and model for end-stage liver disease score. In summary, in patients with acute liver failure without chronic liver disease, HH₁₅ and LHL₁₅ of ^99mTc-GSA scintigraphy are more useful variables in predicting prognosis than serum variables and model for end-stage liver disease score.

DOI： 10.1177/0310057x1304100414

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掲載種別：研究論文（学術雑誌）   出版者・発行元：Springer Science and Business Media LLC  

その他リンク： http://link.springer.com/article/10.1007/s00540-011-1220-6/fulltext.html

DOI： 10.1007/s00540-011-1220-6

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掲載種別：研究論文（学術雑誌）   出版者・発行元：Springer Science and Business Media LLC  

その他リンク： http://link.springer.com/article/10.1007/s00261-005-0349-x/fulltext.html

DOI： 10.1007/s00261-005-0349-x

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記述言語：日本語  

J-GLOBAL

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記述言語：英語  

その他リンク:： http://link.springer.com/article/10.1007/s00268-003-6813-2/fulltext.html

DOI： 10.1007/s00268-003-6813-2

Web of Science

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