{"title":"Focused cardiac ultrasound (FoCUS) and comprehensive echocardiography in the ICU","authors":"Y. Tokita, Takeshi Yamamoto","doi":"10.3918/JSICM.28_419","DOIUrl":"https://doi.org/10.3918/JSICM.28_419","url":null,"abstract":"","PeriodicalId":22583,"journal":{"name":"The Japanese Society of Intensive Care Medicine","volume":"1 1","pages":"419-428"},"PeriodicalIF":0.0,"publicationDate":"2021-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"74346217","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
2016年に敗血症の定義が変更され,Sepsis-3として Society of Critical Care Medicine(SCCM)とEuropean Society of Intensive Medicine(ESCIM)から発表され た。Sepsis-3では敗血症は“感染に対する宿主生体反 応の制御不全に起因する生命を脅かす臓器障害”と定 義された。敗血症は感染に伴うsystemic inflammatory response syndrome(SIRS)ではなく,臓器障 害が起こった状態であるとされた。臓器障害の基準と してSOFA scoreが示された。敗血症性ショックは “sepsisのサブセットで,死亡率を上昇させる重篤な循 環・細胞代謝異常を呈するもの”とされ,“十分な輸液 をしても,平均血圧 65 mmHgを維持するために血管 作動薬が必要,かつ血清乳酸値が2 mmol/Lを超える もの”とされた。同時に,救急患者や一般病棟の患者 でsepsisを 早 期 発 見 す る た め にquick SOFA (qSOFA)が提唱された。ただし,qSOFAに関しては 感度や特異度の問題が指摘されており1),今後変更さ れる可能性もある。
2016年败血症的定义被修改，作为Sepsis-3的Society of Critical Care Medicine(SCCM)和European Society of IntensiveMedicine(ESCIM)发表了这一结果。在Sepsis-3中，败血症被定性为“由于对感染的宿主生物反应的控制不全而引起的威胁生命的脏器障碍”。败血症不是由感染引起的systemic inflammatory response syndrome(SIRS)，而是脏器损害的状态。SOFA score被认为是器官障碍的标准。败血症性休克是“sepsis的子集，表现为使死亡率上升的严重的循环和细胞代谢异常”，“即使充分输液，为了维持平均血压65mmhg，血管需要使用激动剂，且血清乳酸值超过2mmol /L。”同时，针对急救患者和普通病房患者早期发现sepsis，提出了quick SOFA (qSOFA)。不过，qSOFA的灵敏度和特异性问题也被指出1)，今后也有变更的可能性。
{"title":"Pitfalls in the diagnosis of sepsis","authors":"K. Atagi, S. Fukuda, Michitaka Nakamura","doi":"10.3918/JSICM.28_415","DOIUrl":"https://doi.org/10.3918/JSICM.28_415","url":null,"abstract":"2016年に敗血症の定義が変更され,Sepsis-3として Society of Critical Care Medicine(SCCM)とEuropean Society of Intensive Medicine(ESCIM)から発表され た。Sepsis-3では敗血症は“感染に対する宿主生体反 応の制御不全に起因する生命を脅かす臓器障害”と定 義された。敗血症は感染に伴うsystemic inflammatory response syndrome(SIRS)ではなく,臓器障 害が起こった状態であるとされた。臓器障害の基準と してSOFA scoreが示された。敗血症性ショックは “sepsisのサブセットで,死亡率を上昇させる重篤な循 環・細胞代謝異常を呈するもの”とされ,“十分な輸液 をしても,平均血圧 65 mmHgを維持するために血管 作動薬が必要,かつ血清乳酸値が2 mmol/Lを超える もの”とされた。同時に,救急患者や一般病棟の患者 でsepsisを 早 期 発 見 す る た め にquick SOFA (qSOFA)が提唱された。ただし,qSOFAに関しては 感度や特異度の問題が指摘されており1),今後変更さ れる可能性もある。","PeriodicalId":22583,"journal":{"name":"The Japanese Society of Intensive Care Medicine","volume":"1 1","pages":"415-416"},"PeriodicalIF":0.0,"publicationDate":"2021-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"73065743","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"A case of electronic-cigarette or vaping product use-associated lung injury in a young man","authors":"Junichi Fujioka, Shinya Fukuda, Takashi Miyauchi","doi":"10.3918/JSICM.28_465","DOIUrl":"https://doi.org/10.3918/JSICM.28_465","url":null,"abstract":"","PeriodicalId":22583,"journal":{"name":"The Japanese Society of Intensive Care Medicine","volume":"55 1","pages":"465-466"},"PeriodicalIF":0.0,"publicationDate":"2021-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"87036033","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
S. Yoshihiro, T. Tomita, M. Sakuraya, Kazuto Onozuka, Yoshihiro Hashimoto
Objectives: This study aimed to identify factors associated with medication non-adherence at hospital discharge and calculate cut-off values for these factors. Methods: A logistic regression model was prepared using a retrospective dataset of 141 cases. Age, sex, the number of drugs prescribed after ICU discharge, the score on the motor and cognitive compo-nents of the functional independence measure (FIM), and the Charlson comorbidity index score were analyzed as potential independent risk factors for medication non-adherence after discharge. Cut-off values and diagnostic accuracy were evaluated by receiver operating characteristic curve, and the results were calibrated against another retrospective dataset of 72 cases, which was collected over a different period. Results: The age ≥ 75 years (OR 3.81, 95%CI 1.33–10.9) and scoring ≤ 4 on more than one item in the cognitive component of the FIM were found to be independent risk factors for medication non-adherence after ICU discharge. A FIM cognitive score cut-off of ≤ 26 had high diagnostic accuracy (sensitivity 62.5%, specificity 88.1%), and the accuracy ratio was highly consistent between the two datasets. Conclusions: The FIM cognitive score and age at ICU admission were independent risk factors for medication non-adherence after discharge, and the diagnostic accuracy was highest for a FIM cognitive score cut-off of 26 points or less.
{"title":"Factors predicting the inability to self-manage medication after discharge from the intensive care unit: a retrospective cohort study","authors":"S. Yoshihiro, T. Tomita, M. Sakuraya, Kazuto Onozuka, Yoshihiro Hashimoto","doi":"10.3918/JSICM.28_437","DOIUrl":"https://doi.org/10.3918/JSICM.28_437","url":null,"abstract":"Objectives: This study aimed to identify factors associated with medication non-adherence at hospital discharge and calculate cut-off values for these factors. Methods: A logistic regression model was prepared using a retrospective dataset of 141 cases. Age, sex, the number of drugs prescribed after ICU discharge, the score on the motor and cognitive compo-nents of the functional independence measure (FIM), and the Charlson comorbidity index score were analyzed as potential independent risk factors for medication non-adherence after discharge. Cut-off values and diagnostic accuracy were evaluated by receiver operating characteristic curve, and the results were calibrated against another retrospective dataset of 72 cases, which was collected over a different period. Results: The age ≥ 75 years (OR 3.81, 95%CI 1.33–10.9) and scoring ≤ 4 on more than one item in the cognitive component of the FIM were found to be independent risk factors for medication non-adherence after ICU discharge. A FIM cognitive score cut-off of ≤ 26 had high diagnostic accuracy (sensitivity 62.5%, specificity 88.1%), and the accuracy ratio was highly consistent between the two datasets. Conclusions: The FIM cognitive score and age at ICU admission were independent risk factors for medication non-adherence after discharge, and the diagnostic accuracy was highest for a FIM cognitive score cut-off of 26 points or less.","PeriodicalId":22583,"journal":{"name":"The Japanese Society of Intensive Care Medicine","volume":"66 1","pages":"437-443"},"PeriodicalIF":0.0,"publicationDate":"2021-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"83375838","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
K. Nakashima, J. Maki, Keita Takahashi, Kazuhiro Shirozu, Yuji Shono, K. Tokuda, T. Akahoshi, K. Yamaura
Malignant catatonia is a syndrome characterized by psychomotor disorder with autonomic symptoms and hyper-thermia. A 53-year-old woman with schizophrenia presented hyperthermia, immobility, mutism and rigidity, and was transported to our emergency room. After admission to the psychiatric ward, she developed respiratory failure. She was brought to the ICU and intensive care was initiated. After the exclusion of neuroleptic malignant syndrome and other physical diseases, we suspected malignant catatonia due to an exacerbation of schizophrenia. Thus, we administered lorazepam (1 mg, intravenously). Three minutes after the administration of lorazepam, her immobility, mutism and rigidity were ameliorated. When malignant catatonia is suspected, malignant catatonia should be differentially diagnosed from other physical diseases, while general care is provided to prevent complications. Then, a therapeutic diagnosis with lorazepam should be considered. Because lorazepam has a rapid onset, it is appropriate for the diagnosis and treatment of malignant catatonia.
{"title":"A case of malignant catatonia successfully diagnosed and treated with intravenous lorazepam","authors":"K. Nakashima, J. Maki, Keita Takahashi, Kazuhiro Shirozu, Yuji Shono, K. Tokuda, T. Akahoshi, K. Yamaura","doi":"10.3918/JSICM.28_450","DOIUrl":"https://doi.org/10.3918/JSICM.28_450","url":null,"abstract":"Malignant catatonia is a syndrome characterized by psychomotor disorder with autonomic symptoms and hyper-thermia. A 53-year-old woman with schizophrenia presented hyperthermia, immobility, mutism and rigidity, and was transported to our emergency room. After admission to the psychiatric ward, she developed respiratory failure. She was brought to the ICU and intensive care was initiated. After the exclusion of neuroleptic malignant syndrome and other physical diseases, we suspected malignant catatonia due to an exacerbation of schizophrenia. Thus, we administered lorazepam (1 mg, intravenously). Three minutes after the administration of lorazepam, her immobility, mutism and rigidity were ameliorated. When malignant catatonia is suspected, malignant catatonia should be differentially diagnosed from other physical diseases, while general care is provided to prevent complications. Then, a therapeutic diagnosis with lorazepam should be considered. Because lorazepam has a rapid onset, it is appropriate for the diagnosis and treatment of malignant catatonia.","PeriodicalId":22583,"journal":{"name":"The Japanese Society of Intensive Care Medicine","volume":"128 1","pages":"450-453"},"PeriodicalIF":0.0,"publicationDate":"2021-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"78418072","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Takahiro Yamada, Y. Tsujimoto, N. Matsumura, Noriko Monma, H. Okuyama, Mika Kato, K. Morino
{"title":"A case of delayed hemolytic transfusion reaction found to be the D-- phenotype during burn treatment","authors":"Takahiro Yamada, Y. Tsujimoto, N. Matsumura, Noriko Monma, H. Okuyama, Mika Kato, K. Morino","doi":"10.3918/JSICM.28_461","DOIUrl":"https://doi.org/10.3918/JSICM.28_461","url":null,"abstract":"","PeriodicalId":22583,"journal":{"name":"The Japanese Society of Intensive Care Medicine","volume":"30 2 1","pages":"461-462"},"PeriodicalIF":0.0,"publicationDate":"2021-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"90585518","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Trans-catheter treatment for severe functional mitral regurgitation after acute myocardial infarction","authors":"S. Shirai","doi":"10.3918/JSICM.28_417","DOIUrl":"https://doi.org/10.3918/JSICM.28_417","url":null,"abstract":"","PeriodicalId":22583,"journal":{"name":"The Japanese Society of Intensive Care Medicine","volume":"154 1","pages":"417-418"},"PeriodicalIF":0.0,"publicationDate":"2021-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"77121247","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"The future of treatment for respiratory infection with kampo medicine","authors":"Rie Ono, S. Takayama, Ryutaro Arita","doi":"10.3918/JSICM.28_429","DOIUrl":"https://doi.org/10.3918/JSICM.28_429","url":null,"abstract":"要約：昨今の新興ウイルスによる呼吸器感染症では，病原体の変異，多臓器不全をきたす病 態管理の困難さや医療資源の枯渇化が問題となっている。漢方治療では病原体にかかわらず， 感染症の病態を感染経過や宿主の状態から6つの病期ステージに分類し，独自の病態把握に よって漢方薬を適用してきた。過去の繰り返されるパンデミックにおいて，漢方薬は炎症と 急激な病態悪化に対応できるよう工夫された。漢方薬は多成分系薬剤でありその作用機序は 複雑であるが，基礎研究において非特異的抗ウイルス作用，サイトカイン調整作用，臓器保 護作用を有することが示唆されている。集中治療においても宿主の恒常性を調整する概念と 漢方薬の特徴を活かしたアプローチが治療選択の一つとなる可能性がある。","PeriodicalId":22583,"journal":{"name":"The Japanese Society of Intensive Care Medicine","volume":"69 1","pages":"429-435"},"PeriodicalIF":0.0,"publicationDate":"2021-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"89884166","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
京公网安备 11010802042870号
京ICP备2023020795号-1
扫码关注我们
求助内容：
应助结果提醒方式：