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Japanese Clinical Practice Guidelines for Rehabilitation in Critically Ill Patients 2023 (J-ReCIP 2023). 日本危重患者康复临床实践指南2023(J-ReCIP 2023)。
IF 7.1 2区 医学 Q1 Medicine Pub Date : 2023-11-07 DOI: 10.1186/s40560-023-00697-w
Takeshi Unoki, Kei Hayashida, Yusuke Kawai, Shunsuke Taito, Morihide Ando, Yuki Iida, Fumihito Kasai, Tatsuya Kawasaki, Ryo Kozu, Yutaka Kondo, Masakazu Saitoh, Hideaki Sakuramoto, Nobuyuki Sasaki, Ryuichi Saura, Kensuke Nakamura, Akira Ouchi, Saiko Okamoto, Masatsugu Okamura, Tomoki Kuribara, Akira Kuriyama, Yujiro Matsuishi, Norimasa Yamamoto, Shodai Yoshihiro, Taisuke Yasaka, Ryo Abe, Takahito Iitsuka, Hiroyasu Inoue, Yuki Uchiyama, Satoshi Endo, Kazuki Okura, Kohei Ota, Takahisa Otsuka, Daisuke Okada, Kengo Obata, Yukiko Katayama, Naoki Kaneda, Mio Kitayama, Shunsuke Kina, Ryuichi Kusaba, Masanari Kuwabara, Naoki Sasanuma, Masahiro Takahashi, Chihiro Takayama, Naonori Tashiro, Junko Tatsuno, Takahiko Tamura, Mitsuhiro Tamoto, Asuka Tsuchiya, Yusuke Tsutsumi, Tadashi Nagato, Chihiro Narita, Tomohiro Nawa, Tadayoshi Nonoyama, Masatoshi Hanada, Kotaro Hirakawa, Akiko Makino, Hirotaka Masaki, Ryosuke Matsuki, Shinya Matsushima, Wataru Matsuda, Saori Miyagishima, Masaru Moromizato, Naoya Yanagi, Kota Yamauchi, Yuhei Yamashita, Natsuhiro Yamamoto, Keibun Liu, Yuki Wakabayashi, Shinichi Watanabe, Hiroshi Yonekura, Nobuto Nakanishi, Tetsuya Takahashi, Osamu Nishida

Providing standardized, high-quality rehabilitation for critically ill patients is a crucial issue. In 2017, the Japanese Society of Intensive Care Medicine (JSICM) promulgated the "Evidence-Based Expert Consensus for Early Rehabilitation in the Intensive Care Unit" to advocate for the early initiation of rehabilitations in Japanese intensive care settings. Building upon this seminal work, JSICM has recently conducted a rigorous systematic review utilizing the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) methodology. This endeavor resulted in the formulation of Clinical Practice Guidelines (CPGs), designed to elucidate best practices in early ICU rehabilitation. The primary objective of this guideline is to augment clinical understanding and thereby facilitate evidence-based decision-making, ultimately contributing to the enhancement of patient outcomes in critical care settings. No previous CPGs in the world has focused specifically on rehabilitation of critically ill patients, using the GRADE approach. Multidisciplinary collaboration is extremely important in rehabilitation. Thus, the CPGs were developed by 73 members of a Guideline Development Group consisting of a working group, a systematic review group, and an academic guideline promotion group, with the Committee for the Clinical Practice Guidelines of Early Mobilization and Rehabilitation in Intensive Care of the JSICM at its core. Many members contributed to the development of the guideline, including physicians and healthcare professionals with multiple and diverse specialties, as well as a person who had been patients in ICU. Based on discussions among the group members, eight important clinical areas of focus for this CPG were identified. Fourteen important clinical questions (CQs) were then developed for each area. The public was invited to comment twice, and the answers to the CQs were presented in the form of 10 GRADE recommendations and commentary on the four background questions. In addition, information for each CQ has been created as a visual clinical flow to ensure that the positioning of each CQ can be easily understood. We hope that the CPGs will be a useful tool in the rehabilitation of critically ill patients for multiple professions.

为危重患者提供标准化、高质量的康复是一个至关重要的问题。2017年,日本重症监护医学会(JSICM)颁布了“重症监护室早期康复循证专家共识”,倡导在日本重症监护环境中尽早开始康复。在这项开创性工作的基础上,JSICM最近利用建议、评估、发展和评估分级(GRADE)方法进行了严格的系统审查。这项努力导致了临床实践指南(CPG)的制定,旨在阐明早期ICU康复的最佳实践。本指南的主要目的是增强临床理解,从而促进循证决策,最终有助于提高重症监护环境中的患者结果。世界上以前没有一个CPG专门关注危重患者的康复,使用GRADE方法。多学科合作在康复方面极为重要。因此,CPG是由指导方针制定小组的73名成员制定的,该小组由一个工作组、一个系统审查小组和一个学术指导方针推广小组组成,以JSICM重症监护早期动员和康复临床实践指导方针委员会为核心。许多成员为该指南的制定做出了贡献,包括具有多种不同专业的医生和医疗保健专业人员,以及一名曾在重症监护室接受治疗的患者。根据小组成员之间的讨论,确定了该CPG的八个重要临床重点领域。然后为每个领域制定了14个重要的临床问题(CQ)。公众被邀请发表两次评论,CQ的答案以10个GRADE建议和对四个背景问题的评论的形式呈现。此外,每个CQ的信息已被创建为视觉临床流,以确保可以容易地理解每个CQ定位。我们希望CPG将成为多种职业危重患者康复的有用工具。
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引用次数: 0
THE EFFECTIVENESS OF BRUNO MARS SONG IN DOO-WOPS & HOOLIGANS ALBUM ON STUDENTS' PRONUNCIATION MASTERY 布鲁诺·马尔斯的歌曲在DOO-WOPS中的效果流氓关于学生发音掌握的相册
2区 医学 Q1 Medicine Pub Date : 2023-10-31 DOI: 10.31602/intensive.v6i2.12851
Imas Kurnia Sari
The aim of this research is to find out the effect and significant difference of bruno mars song in doo-wops & hooligans album for students' pronunciation mastery at Vocational High School Kartikatama Metro. Song is a media in the form of musical works that are suitable for teaching English, especially pronunciation. This research used quasi experimental design. The subjects of this research are the tenth grade students at Vocational High School Kartikatama Metro. The result of data analysis indicates that value of t obtained (to) is lower than value of t table (-16.482<2.074). Moreover, the second data indicates t obtained (to) is lower than value of t table (-13.657<2021). The conclusion are teaching English pronunciation using bruno mars song in doo-wops & hooligans album is effective to increase students' pronunciation mastery and gives a significant differences. Researchers hope that this research can help future researchers to conduct similar research, especially when using English songs to teach pronunciation. Future researchers must use the latest songs in conducting further research.
本研究的目的在于找出布鲁诺·马尔斯的歌曲在《杜沃普舞曲》中的效果及显著性差异。专为Kartikatama Metro职业高中学生的语音掌握而设计的流氓相册。歌曲是一种适合于英语教学,尤其是发音教学的音乐作品形式的媒介。本研究采用准实验设计。本研究以Kartikatama Metro职业高中十年级学生为研究对象。数据分析结果表明,得到的t的值(to)小于t表的值(-16.482<2.074)。并且,第二组数据表明,得到的t (to)小于t表(-13.657<2021)的值。本文的结论是利用布鲁诺·马尔斯的歌曲进行英语发音教学。流氓相册对提高学生的语音掌握效果显著,差异显著。研究人员希望这项研究可以帮助未来的研究人员进行类似的研究,特别是在使用英文歌曲来教发音的时候。未来的研究人员必须使用最新的歌曲进行进一步的研究。
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引用次数: 0
THE EFFECTIVENESS OF WEB-BASED LEARNING ON THE STUDENTS’ MOTIVATION AND ABILITY IN WRITING NARRATIVE TEXT 网络学习对学生叙事语篇写作动机和能力的影响
2区 医学 Q1 Medicine Pub Date : 2023-10-31 DOI: 10.31602/intensive.v6i2.8617
Nur Rahmadani, Nurhaeni Nurhaeni
In English, there are four skills which must be mastered, they are listening, speaking, reading, and writing. One of the language skills is writing that important for learners to practice their capability and their understanding, how to send ideas, and how to arrange words well. The objectives of this study were students’ motivation and ability to write narrative text who are taught through web-based learning, the writing motivation and ability of students who are not taught through web-based learning and to find out whether or not there is a significant effect of web-based learning to the students' motivation and ability to write narrative text for tenth-grade students of senior high school. The research was conducted at Muhammadiyah Boarding School in Prambanan Yogyakarta. This study used experimental research with nonrandomized-groups pre-test post-test control group design as the research design. The data were collected by using tests and questionnaires in the form of pre-test and post-test. The result of inferential analysis, showed by the result of the t-test, was found that the value of the ttable (2.001) was lower than the tobtained (3.532). Thus, H0 is rejected and H1 is accepted. It means that web-based learning had a significant effect on improving students’ writing motivation and ability.
在英语中,有四项技能必须掌握,他们是听,说,读,写。其中一项语言技能是写作,这对学习者练习他们的能力和理解力,如何表达想法,以及如何组织好单词很重要。本研究的目的是通过网络学习教学的学生的叙事文本写作动机和能力,以及非网络学习教学的学生的写作动机和能力,并研究网络学习对高中十年级学生叙事文本写作动机和能力是否有显著的影响。这项研究是在日惹普兰巴南的Muhammadiyah寄宿学校进行的。本研究采用非随机分组实验研究,前测后测对照组设计为研究设计。采用前测和后测两种形式的测试和问卷收集数据。通过t检验的结果进行推理分析,发现表的值(2.001)低于得到的值(3.532)。因此,H0被拒绝,H1被接受。这意味着网络学习对提高学生的写作动机和写作能力有显著的效果。
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引用次数: 0
IMPROVING THE STUDENTS’ VOCABULARY MASTERY BY USING WORD SQUARE MEDIA COMPARATIVE STUDY OF USING KWL AND QAR STRATEGIES ON STUDENTS’ READING COMPREHENSION 运用词方媒介提高学生的词汇掌握:KWL策略与qar策略在学生阅读理解中的比较研究
2区 医学 Q1 Medicine Pub Date : 2023-10-31 DOI: 10.31602/intensive.v6i2.12696
Sri - Lestari
Reading is a complex activity. Through reading activities, readers have responses like rejection, acceptance, and criticism of what they have read. Therefore, appropriate strategies are needed in reading learning activities for students to facilitate reading comprehension. This study aims to determine significant differences in using KWL and QAR strategies on students' reading comprehension abilities.This study used an experimental method with a post-test-only design. The population in this study were students of class VIII SMPN 5 Banjarmasin. The sampling technique used in this study was using a saturated sampling technique for as many as 261 students. The instrument used was multiple choice questions in the form of a post-test. The data analysis technique in this study was the t-test at a significance level of 5%.The results showed that the student's reading comprehension who were taught by using the KWL strategy was 52.09 lower than those of the students taught by using the QAR strategy of 57.09 with a tcount of 2.251 and a p of 0.025 (p < 0.05 ). The difference in the post-test mean of reading comprehension skills in the KWL strategy group and the QAR strategy group was 5.00. This shows that there is a significant difference in the use of KWL and QAR strategies on the reading comprehension skills of eight grade students at SMPN 5 Banjarmasin.
阅读是一项复杂的活动。通过阅读活动,读者会对所读的内容产生拒绝、接受和批评等反应。因此,学生在阅读学习活动中需要适当的策略来促进阅读理解。本研究旨在确定使用KWL策略和QAR策略对学生阅读理解能力的显著差异。本研究采用后验设计的实验方法。本研究人群为八级SMPN 5 Banjarmasin学生。本研究采用的抽样技术为饱和抽样技术,对261名学生采用饱和抽样技术。使用的工具是后测形式的多项选择题。本研究数据分析采用显著性水平为5%的t检验。结果显示,使用KWL策略教学的学生阅读理解能力比使用QAR策略教学的学生57.09低52.09,差异为2.251,p为0.025 (p <0.05)。KWL策略组与QAR策略组的阅读理解能力测试后均值差异为5.00。这表明,在使用KWL和QAR策略对八年级学生阅读理解技能的影响上存在显著差异。
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引用次数: 0
IMPROVING THE STUDENTS’ VOCABULARY MASTERY BY USING WORD SQUARE MEDIA 运用词方块媒介提高学生的词汇掌握能力
2区 医学 Q1 Medicine Pub Date : 2023-10-31 DOI: 10.31602/intensive.v6i2.12886
Ian Harum Prasasti, Yasmika Baihaqi, Bambang Eko Siagiyanto, Fitri Palupi Kusumawati, Winda Amilia
The purpose of this research is to find out whether using word square media can improve the vocabulary mastery of the eleventh grade students of SMK Negeri 3 Metro. In this study, researchers conducted classroom action research (CAR) which was carried out in three cycles. Each cycle consists of planning, acting, observing and reflecting. The subjects of this study were 32 students of eleventh grade at SMK Negeri 3 Metro. In collecting data, researchers used pre-test, post-test 1, post-test 2, post-test 3, observing, interview, and questionnaire. The results of the study show that using Word square media can improve stu-dents’ vocabulary mastery at eleventh grade of SMK Negeri 3 Metro, this can be seen in the progress of the pre-test and post-test cycle 1 to cycle 3. the average of pre-test score was 42.31% and the post-test in cycle 1 was 61.37%, the average value in post-test 2 was 75.40% and the average score in cycle 3 was 81.37%. pre-test and post-test cycle 1 to post-test cy-cle 3 there was an increase of 5.97%. it means that the results of the post test have reached indicators of success that can be achieved on the results of this post-test. Students responses in using word square media that have been done can be seen that 93.45% of students gave respones very positive in learning using word square learning media and word square media can be said to be practical and easy to use for students, this can be seen from the enthusiasm of students and their spirits at the first time in using word square media.
本研究的目的是为了了解使用文字方块媒体是否可以提高SMK Negeri 3 Metro高中一年级学生的词汇掌握水平。在本研究中,研究者进行了课堂行动研究(CAR),分三个周期进行。每个循环由计划、行动、观察和反思组成。本研究的对象是32名南国三城中学高一年级的学生。在收集数据时,研究者采用了前测、后测1、后测2、后测3、观察法、访谈法和问卷法。研究结果表明,使用Word square媒体可以提高SMK Negeri 3 Metro高二学生的词汇掌握水平,这可以从测试前和测试后的第1周期到第3周期的进度中看出。第1周期前测平均值为42.31%,后测平均值为61.37%,第2周期后测平均值为75.40%,第3周期后测平均值为81.37%。测试前和测试后第1周期至测试后第3周期,增加了5.97%。这意味着后测试的结果已经达到了成功的指标,可以在这个后测试的结果上实现。从已经做过的学生使用词方媒体的反应可以看出,93.45%的学生对使用词方学习媒体的学习反应非常积极,词方媒体对学生来说可以说是实用、好用的,这可以从学生第一次使用词方媒体的热情和精神上看出。
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引用次数: 0
INCORPORATING CEFR PRINCIPLES IN THE DEVELOPMENT OF A HYPERTEXT POETRY LEARNING PLATFORM FOR HIGH SCHOOL STUDENTS 结合cefr原则开发高中超文本诗歌学习平台
2区 医学 Q1 Medicine Pub Date : 2023-10-27 DOI: 10.31602/intensive.v6i2.12728
Sinta Indriyani, Lala Bumela Sudimantara
This study examines the decline of English education in Indonesia and the need for innovative teaching methods to improve students' English proficiency. Despite Indonesia's low ranking on the English Proficiency Index, the traditional teaching approach remains prevalent, which focuses on grammar and vocabulary. The research by Sudimantara (2021) and highlight the benefits of non-traditional approaches such as incorporating nonverbal components. Lian A.-B (2017) also creates an innovative approach called reading for emotion to help students learn English better without worrying about grammar and vocabulary. The study also shows the importance of poetry and literature in English language learning, as proven by Zeman, A., Milton, F., Smith, A., & Rylance, R. (2015) that poetry precedes prose and it is a knowledge management system in the world. The study employed a research and development design to demonstrate the collaboration of using pedagogy, technology, and CEFR to create innovative learning resources that shift students' mindsets and also build the students’ engagement in learning English. This study offers valuable insights into developing innovative learning resources for English language learning in Indonesia, and further research in this area could lead to more effective teaching methods and improve the English proficiency of Indonesian students.
本研究探讨了印尼英语教育的衰落,以及创新教学方法以提高学生英语水平的必要性。尽管印尼在英语水平指数上排名较低,但传统的教学方法仍然盛行,主要集中在语法和词汇上。Sudimantara(2021)的研究强调了非传统方法的好处,如纳入非语言成分。Lian A.-B(2017)还创造了一种名为“情感阅读”的创新方法,帮助学生更好地学习英语,而不用担心语法和词汇。该研究还表明诗歌和文学在英语语言学习中的重要性,正如泽曼,弥尔顿,F,史密斯,A, &;Rylance, R.(2015)认为诗歌先于散文,是世界上的一种知识管理系统。本研究采用了研发设计,展示了运用教学法、技术和CEFR来创造创新的学习资源,从而改变学生的思维方式,并提高学生对英语学习的参与度。本研究为开发印尼英语语言学习的创新学习资源提供了有价值的见解,在这一领域的进一步研究可能会导致更有效的教学方法,提高印尼学生的英语水平。
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引用次数: 0
THE IMPLEMENTATION OF TECHNOLOGY-BASED LEARNING EVALUATION TO INCREASE ENGLISH STUDENTS' LEARNING MOTIVATION: CASE STUDY OF E-PORTFOLIO USE 实施基于技术的学习评价提高英语学生的学习动机:电子档案袋使用案例研究
2区 医学 Q1 Medicine Pub Date : 2023-10-26 DOI: 10.31602/intensive.v6i2.12543
Noor Aida Aflahah, Miftah Al Farhan, Hafizhatu Nadia, Asyifa Asyifa
This research aims to explore in depth the use of learning evaluation using technology, namely Google Site, which seeks to develop and increase student motivation and creativity in carrying out requested evaluations. This study is an intrinsic case study which was theoretically rooted in a unique case. The case raised in this research was the potential use of e-portfolios as an alternative option in evaluating technology-based learning. This study involved one lecturer and three students as research participants who were selected based on certain criteria or by purposive sampling technique. Lecturers were selected based on their experience in implementing e-portfolios to evaluate learning, and the students were participants in the learning. Research data were collected through semi-structured interviews with open questions, direct observation, and Focus Group Discussion (FGD). The results of this study confirmed the students gave similar opinions stating that e-portfolios could increase their extrinsic and intrinsic motivation. This research only focused on students' opinions regarding the implementation of e-portfolios in increasing their learning motivation. It is hoped that future research can further explore teachers' opinions for more comprehensive results.
本研究旨在深入探索使用技术,即谷歌网站的学习评估的使用,旨在发展和增加学生在进行要求的评估时的动机和创造力。本研究是一个内在的案例研究,其理论根源于一个独特的案例。本研究提出的案例是电子档案作为评估基于技术的学习的另一种选择的潜在用途。本研究涉及一名讲师和三名学生作为研究参与者,他们是根据一定的标准或通过有目的的抽样技术选择的。讲师是根据他们在实施电子档案评估学习方面的经验来选择的,学生是学习的参与者。研究数据通过开放式问题、直接观察和焦点小组讨论(FGD)的半结构化访谈收集。本研究的结果证实了学生对电子档案可以增加他们的外在动机和内在动机的观点相似。本研究只关注学生对实施电子档案对提高学习动机的看法。希望今后的研究能够进一步挖掘教师的意见,得到更全面的结果。
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引用次数: 0
THE EFFECT OF USING AUTHENTIC MATERIALS ON READING COMPREHENSION ACROSS SECONDARY STUDENT’ COGNITIVE LEARNING STYLE 使用真实材料对中学生认知学习风格阅读理解的影响
2区 医学 Q1 Medicine Pub Date : 2023-10-22 DOI: 10.31602/intensive.v6i2.8616
Noor Aisyah, Aulia Azmi
The teaching of reading nowadays is urged to empower students to cope with 21st century literacy challenges and to develop prevailing 21st century. Further, English teachers have to implement interesting and creative materials and strategies to motivate students in learning English. Compared to non-authentic materials, authentic materials seemed more promising to fulfill the demand. The aim of this study was to investigate whether or not the use of authentic materials in the classroom in teaching reading comprehension is effective toward students’ cognitive learning styles. The effect of authentic materials was compared to the non-authentic ones. This study employed a quasi-factorial 2 x 2 design and involved 68 tenth graders SMKN 3 Banjarmasin, South Kalimantan Province. The instruments used were reading comprehension posttest and GEFT. Statistical analysis was performed using SPSS 23.0 to test hypotheses at .05 level of significance. The results showed that authentic materials improved students’ reading comprehension compared to the non-authentic ones. It conforms to the theory of authentic materials and the previous studies indicating authentic material is effective in improving students’ reading comprehension. It was further found that there was no significant difference in the reading comprehension between field independent and field dependent students. Based on the results, it can be concluded that using authentic materials is promising alternative materials to help students increase students’ reading comprehension with different cognitive learning styles.
当今的阅读教学被要求使学生能够应对21世纪的识字挑战,并发展21世纪的主流。此外,英语教师必须使用有趣和有创意的材料和策略来激励学生学习英语。与非真实材料相比,真实材料似乎更有可能满足需求。本研究的目的是探讨在课堂上使用真实材料进行阅读理解教学是否对学生的认知学习风格有效。比较了真实材料与非真实材料的效果。本研究采用准因子2 × 2设计,研究对象为南加里曼丹省班加马辛市SMKN 3小学10年级学生68名。使用的工具是阅读理解后测和GEFT。采用SPSS 23.0进行统计学分析,检验假设,显著性水平为0.05。结果表明,与非真实材料相比,真实材料提高了学生的阅读理解能力。这符合真实材料理论和以往的研究表明,真实材料对提高学生的阅读理解是有效的。本研究进一步发现,领域独立学生和领域依赖学生在阅读理解上没有显著差异。综上所述,在不同认知学习风格的学生中,使用真实材料是一种很有前景的替代材料,可以帮助学生提高阅读理解能力。
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引用次数: 0
A CONTENT ANALYSIS OF THE READING COMPREHENSION QUESTIONS IN THE TEXTBOOK ENDORSED BY THE GOVERNMENT 政府认可的教科书中阅读理解问题的内容分析
2区 医学 Q1 Medicine Pub Date : 2023-10-20 DOI: 10.31602/intensive.v6i2.8350
Aulia Azmi, Noor Aisyah
Material is a component of teaching to create a successful teaching and learning process. The purpose of this study is to describe the content of reading material in “Bahasa Inggris” textbook which endorsed by the government, especially the cognitive levels of the questions that follow the reading texts. This study used the qualitative research design. Meanwhile, the qualitative data of the research were cognitive level of questions that followed the reading texts. The researcher also used content analysis which was as one of the techniques used in qualitative research to collect and analyze the data of the textbook. Moreover, the instruments for analyzing cognitive level of questions that followed the reading texts were a checklist proposed by Igbaria (2013) and a guide for deciding the level of the questions based on the cognitive domain of Bloom’s taxonomy. The result showed that cognitive levels of questions that followed the reading texts found that 125 questions (89.9%) which were categorized as lower order thinking skills. Meanwhile, there were 14 (10.07%) questions which were categorized as higher order thinking skills. Thus, the questions which were categorized as Lower-order Thinking Skills (LOTS) were more dominant in the textbook.
材料是教学的一个组成部分,可以创造一个成功的教与学过程。本研究的目的是描述政府认可的“马来文”教科书中阅读材料的内容,特别是阅读文本后面的问题的认知水平。本研究采用定性研究设计。同时,本研究的定性数据为阅读文本后问题的认知水平。研究人员还使用了定性研究中使用的技术之一内容分析来收集和分析教科书的数据。此外,用于分析阅读文本后问题认知水平的工具是Igbaria(2013)提出的清单和基于Bloom分类法的认知领域决定问题水平的指南。结果表明,阅读文本后的认知问题水平发现125个问题(89.9%)被归类为低阶思维技能。同时,有14个(10.07%)问题被归类为高阶思维技能。因此,被归类为低阶思维技能(lot)的问题在教科书中占主导地位。
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引用次数: 0
Trends in massive transfusion practice for trauma in Japan from 2011 to 2020: a nationwide inpatient database study. 2011年至2020年日本大规模创伤输血实践的趋势:一项全国住院患者数据库研究。
IF 7.1 2区 医学 Q1 Medicine Pub Date : 2023-10-18 DOI: 10.1186/s40560-023-00685-0
Hiroyuki Ohbe, Takashi Tagami, Akira Endo, Shigeki Miyata, Hiroki Matsui, Kiyohide Fushimi, Shigeki Kushimoto, Hideo Yasunaga

Background: Previous studies have reported conflicting results regarding fresh frozen plasma (FFP)-to-red blood cell (RBC) ratio and platelet-to-RBC ratio on outcomes for massive transfusion for trauma. Moreover, nationwide data on massive transfusion practices for trauma in the real-world clinical setting are scarce. This study aimed to examine the nationwide practice patterns and trends in massive transfusion for trauma in Japan using a national administrative, inpatient database.

Method: We identified patients who underwent emergency hospitalization for trauma and received massive transfusion, defined as administration of at least 20 units of RBC within the first 2 days of admission, using the nationwide inpatient database, which covers approximately 90% of all tertiary emergency hospitals in Japan, between 2011 and 2020. Trends in the incidence and practice patterns of massive transfusion were described by calendar year. The association of practice patterns with mortality or adverse events was tested.

Results: A total of 3,530,846 trauma hospitalizations were identified, of which 5247 (0.15%) received massive transfusion. A significant declining trend was observed in the incidence of massive transfusion in trauma hospitalizations from 0.24% in 2011 to 0.10% in 2020 (P for trend < 0.001). The FFP-to-RBC ratio rose significantly from 0.77 in 2011 to 1.08 in 2020 (P for trend < 0.001), while the platelet-to-RBC ratio remained virtually unchanged from 0.71 in 2011 to 0.78 in 2020 (P for trend 0.060). Massive transfusion with lower FFP-to-RBC (< 0.75) and platelets-to-RBC ratio (< 1.00) were associated with increased in-hospital mortality compared with those ≥ 1.00, while there were linear increases in adverse events with increasing FFP and platelets ratios.

Conclusions: This study demonstrated a declining trend in the incidence and a rise in higher FFP-to-RBC ratios in massive transfusion in association with patient outcomes for trauma from 2011 to 2020 in Japan.

背景:先前的研究报道了新鲜冷冻血浆(FFP)与红细胞(RBC)的比率和血小板与红细胞的比率对创伤大规模输血结果的相互矛盾的结果。此外,在现实世界的临床环境中,关于大规模创伤输血实践的全国性数据很少。本研究旨在利用国家行政和住院数据库,研究日本全国范围内大规模创伤输血的实践模式和趋势。方法:我们使用覆盖日本约90%三级急救医院的全国住院数据库,确定了2011年至2020年间因创伤紧急住院并接受大量输血的患者,即在入院前2天内至少注射20个单位的红细胞。按日历年描述了大规模输血的发生率和实践模式的趋势。测试了实践模式与死亡率或不良事件的相关性。结果:共有3530846名创伤住院患者,其中5247人(0.15%)接受了大量输血。创伤住院中大量输血的发生率有显著下降趋势,从2011年的0.24%下降到2020年的0.10%(趋势P 结论:这项研究表明,从2011年到2020年,在日本,大量输血的发病率呈下降趋势,FFP与RBC的比值升高,这与创伤患者的预后有关。
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Journal of Intensive Care
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