Teppei Tokumaru, Hideaki Kurata, Rei Nakaebisu, Joji Tomioka
Background
Surgery for incisional hernias with obesity can be more challenging because obesity is associated with perioperative complications. Necrotizing soft tissue infection (NSTI) is a life-threatening condition that requires aggressive surgical management. Few incisional hernias with NSTI have been reported, and the optimal strategy is undetermined.
Case Presentation
A 66-year-old obese woman had been diagnosed with incisional hernia 4 years previously but was not treated. She presented with abdominal pain that had worsened 2 weeks previously. Emergency radical surgery was carried out for an incisional hernia with NSTI. The abdominal fascia was sutured directly without mesh. Negative pressure wound therapy was performed after surgery. The postoperative course was uneventful, without recurrence.
Conclusions
Aggressive surgery is a valid strategy for life-threatening incisional hernias with NSTI. Strategies should be developed based on physiological and anatomical findings.
{"title":"Aggressive surgery for incisional hernia with necrotizing soft tissue infection highlighting unique abdominal findings","authors":"Teppei Tokumaru, Hideaki Kurata, Rei Nakaebisu, Joji Tomioka","doi":"10.1002/ams2.907","DOIUrl":"https://doi.org/10.1002/ams2.907","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Surgery for incisional hernias with obesity can be more challenging because obesity is associated with perioperative complications. Necrotizing soft tissue infection (NSTI) is a life-threatening condition that requires aggressive surgical management. Few incisional hernias with NSTI have been reported, and the optimal strategy is undetermined.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Case Presentation</h3>\u0000 \u0000 <p>A 66-year-old obese woman had been diagnosed with incisional hernia 4 years previously but was not treated. She presented with abdominal pain that had worsened 2 weeks previously. Emergency radical surgery was carried out for an incisional hernia with NSTI. The abdominal fascia was sutured directly without mesh. Negative pressure wound therapy was performed after surgery. The postoperative course was uneventful, without recurrence.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Aggressive surgery is a valid strategy for life-threatening incisional hernias with NSTI. Strategies should be developed based on physiological and anatomical findings.</p>\u0000 </section>\u0000 </div>","PeriodicalId":7196,"journal":{"name":"Acute Medicine & Surgery","volume":null,"pages":null},"PeriodicalIF":1.6,"publicationDate":"2023-11-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/ams2.907","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138439826","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Multicenter collaborative research accelerates patient recruitment and strengthens evidence. Nevertheless, the factors influencing emergency and critical care physicians’ involvement in such research in Japan remain unclear.
Methods
A nationwide web-based survey conducted in early 2023 targeted emergency physicians working a minimum of 3 days per week in Japan. The survey descriptively assessed their backgrounds, work and research environments, experiences, and perceived impediments and motivators for multicenter research.
Results
Of the 387 respondents, 348 were included in the study, yielding a 5.1% response rate. Women comprised 11% of the participants; 33% worked in university hospitals, 65% served in both emergency departments and intensive care units, and 54% did shift work. Only 12% had designated research time during working hours, with a median of 1 hour per week (interquartile range 0–5 h), including time outside of work. While 73% had participated in multicenter research, 58% noted barriers to participation. The key obstacles were excessive data entry (72%), meeting time constraints (59%), ethical review at each facility (50%), and unique sample collection, such as bronchoalveolar lavage specimens or pathological tissues (51%). The major incentives were networking (70%), data sets reuse (65%), feedback on research results (63%), and recognition from academic societies (63%). Financial rewards were not highly prioritized (38%).
Conclusions
While valuing clinical research, emergency physicians face barriers, especially data entry burden and limited research time. Networking and sharing research findings motivate them. These insights can guide strategies to enhance collaborative research in emergency and critical care in Japan.
{"title":"Challenges hindering emergency physicians; involvement in multicenter collaborative studies in Japan: A nationwide survey analysis","authors":"Manaho Yasuda, Ayaka Saito, Tadahiro Goto, Ryohei Yamamoto, Keibun Liu, Akira Kuriyama, Yutaka Kondo, Daisuke Kasugai, RED-PAM study investigators","doi":"10.1002/ams2.906","DOIUrl":"https://doi.org/10.1002/ams2.906","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Aim</h3>\u0000 \u0000 <p>Multicenter collaborative research accelerates patient recruitment and strengthens evidence. Nevertheless, the factors influencing emergency and critical care physicians’ involvement in such research in Japan remain unclear.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>A nationwide web-based survey conducted in early 2023 targeted emergency physicians working a minimum of 3 days per week in Japan. The survey descriptively assessed their backgrounds, work and research environments, experiences, and perceived impediments and motivators for multicenter research.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Of the 387 respondents, 348 were included in the study, yielding a 5.1% response rate. Women comprised 11% of the participants; 33% worked in university hospitals, 65% served in both emergency departments and intensive care units, and 54% did shift work. Only 12% had designated research time during working hours, with a median of 1 hour per week (interquartile range 0–5 h), including time outside of work. While 73% had participated in multicenter research, 58% noted barriers to participation. The key obstacles were excessive data entry (72%), meeting time constraints (59%), ethical review at each facility (50%), and unique sample collection, such as bronchoalveolar lavage specimens or pathological tissues (51%). The major incentives were networking (70%), data sets reuse (65%), feedback on research results (63%), and recognition from academic societies (63%). Financial rewards were not highly prioritized (38%).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>While valuing clinical research, emergency physicians face barriers, especially data entry burden and limited research time. Networking and sharing research findings motivate them. These insights can guide strategies to enhance collaborative research in emergency and critical care in Japan.</p>\u0000 </section>\u0000 </div>","PeriodicalId":7196,"journal":{"name":"Acute Medicine & Surgery","volume":null,"pages":null},"PeriodicalIF":1.6,"publicationDate":"2023-11-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/ams2.906","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138432228","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
We retrospectively investigated the current status of poisoned patients who had been transported by a physician-staffed helicopter emergency medical service and their final outcomes using data from the JAPAN DOCTOR HELICOPTER REGISTRY SYSTEM.
Methods
The following details of dispatch activity were collected from the database of the JAPAN DOCTOR HELICOPTER REGISTRY SYSTEM: patient age and sex, timing of dispatch request, presence of cardiac arrest, vital signs, medical intervention, main etiology of intoxication, and final outcome. The patients were divided into two groups: those with a good outcome and those with a poor outcome. The variables were compared between the two groups.
Results
A total of 336 patients were intoxicated. Psychotropic drug overdose was the dominant cause, followed by carbon monoxide and ethanol. The median Glasgow Coma Scale score was significantly higher in the good outcome group than in the poor outcome group. The rates of cardiac arrest, interventions to secure an airway and/or assist with ventilation, and drug administration were significantly lower in the good outcome group than in the poor outcome group. There were no records concerning the decontamination of the intoxicating substance at the scene or during air evacuation.
Conclusion
The study suggests that various factors may influence the outcomes of patients with different types of intoxication. These findings offer valuable insights that could help to establish effective treatment strategies and the operation of doctor helicopters for intoxicated patients.
{"title":"Outcome in intoxicated patients transported by a physician-staffed helicopter in Japan from 2015 to 2020","authors":"Youichi Yanagawa, Ikuto Takeuchi, Hiroki Nagasawa, Hiromichi Ohsaka, Kouhei Ishikawa","doi":"10.1002/ams2.904","DOIUrl":"10.1002/ams2.904","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Aim</h3>\u0000 \u0000 <p>We retrospectively investigated the current status of poisoned patients who had been transported by a physician-staffed helicopter emergency medical service and their final outcomes using data from the JAPAN DOCTOR HELICOPTER REGISTRY SYSTEM.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>The following details of dispatch activity were collected from the database of the JAPAN DOCTOR HELICOPTER REGISTRY SYSTEM: patient age and sex, timing of dispatch request, presence of cardiac arrest, vital signs, medical intervention, main etiology of intoxication, and final outcome. The patients were divided into two groups: those with a good outcome and those with a poor outcome. The variables were compared between the two groups.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>A total of 336 patients were intoxicated. Psychotropic drug overdose was the dominant cause, followed by carbon monoxide and ethanol. The median Glasgow Coma Scale score was significantly higher in the good outcome group than in the poor outcome group. The rates of cardiac arrest, interventions to secure an airway and/or assist with ventilation, and drug administration were significantly lower in the good outcome group than in the poor outcome group. There were no records concerning the decontamination of the intoxicating substance at the scene or during air evacuation.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>The study suggests that various factors may influence the outcomes of patients with different types of intoxication. These findings offer valuable insights that could help to establish effective treatment strategies and the operation of doctor helicopters for intoxicated patients.</p>\u0000 </section>\u0000 </div>","PeriodicalId":7196,"journal":{"name":"Acute Medicine & Surgery","volume":null,"pages":null},"PeriodicalIF":1.6,"publicationDate":"2023-11-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10622606/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"71476953","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Jessica L. Beadle, Sarah M. Perman, Justin Pennington, David F. Gaieski
Aim
We sought to collect granular data on temperature burden to further explore existing conflicting information on the relationship between temperature alterations and outcomes in patients with sepsis requiring hospital admission.
Methods
This was a prospective cohort study that enrolled a convenience sample of patients with sepsis or septic shock admitted to the hospital from the emergency department (ED). A “unit of temperature burden (UTB)” was defined as >1°C (1.8°F) above or below 37°C (98.6°F) for 1 min. Fever burden was defined as the number of UTBs >38°C (100.4°F). The primary objective was to calculate the fever burden in patients with sepsis during their ED stay. This was analyzed for patients who present to triage febrile or hypothermic and also for those who developed temperature abnormalities during their ED stay. The secondary objectives were correlating fever and hypothermia burden with in-hospital mortality, Systemic Inflammatory Response Syndrome (SIRS) criteria, and the quick Sequential (Sepsis-Associated) Organ Failure Assessment (qSOFA) score and identification of patients who may benefit from early implementation of targeted temperature management.
Results
A total of 256 patients met the inclusion criteria. The mean age of patients was 60.1 ± 18.4 years; 46% were female and 29.6% were black. The median (interquartile range [IQR]) fever burden for the fever in triage cohort (n = 99) was 364.6 (174.3-716.8) UTB and for the no fever in triage cohort (n = 157) was 179.3 (80.9-374.0) UTB (p = 0.005). The two groups had similar in-hospital mortality (6.1 vs 8.3%; p = 0.5). The median fever burden for the fever anytime cohort was 303.8 (IQR 138.8-607.9) UTB and they had lower mortality than the no fever anytime cohort (4.7% vs 11.2%; p = 0.052). Patients with fever at triage had higher mean SIRS criteria than those without (2.8 vs 2.0; p < 0.001) while qSOFA points were similar (p = 0.199). A total of 27 patients had hypothermia during their ED stay and these patients were older with higher mean SIRS criteria.
Conclusions
Patients with sepsis and septic shock have a significant temperature burden in the ED. When comparing patients who had fever at any time during their ED stay with those who never had a fever, a trend toward an inverse relationship between fever burden and mortality was found.
目的:我们试图收集关于温度负担的颗粒数据，以进一步探索需要住院的败血症患者温度变化与预后之间关系的现有相互矛盾的信息。方法:这是一项前瞻性队列研究，纳入了从急诊科(ED)入院的脓毒症或感染性休克患者的方便样本。“温度负荷单位(UTB)”定义为高于或低于37°C(98.6°F) 1分钟1°C(1.8°F)。发热负担定义为38°C(100.4°F)的utb数量。主要目的是计算败血症患者在急诊科住院期间的发热负担。分析了出现发热或体温过低的患者以及在急诊科住院期间出现体温异常的患者。次要目标是将发热和低温负担与住院死亡率、全身炎症反应综合征(SIRS)标准、快速序事性(败血症相关)器官衰竭评估(qSOFA)评分以及确定可能从早期实施靶向温度管理中受益的患者之间的关系。结果256例患者符合纳入标准。患者平均年龄60.1±18.4岁;46%为女性，29.6%为黑人。分诊组发热组(n = 99)发热负荷中位数(四分位间距[IQR])为364.6 (174.3-716.8)UTB，无发热组(n = 157)发热负荷中位数(80.9-374.0)UTB (p = 0.005)。两组的住院死亡率相似(6.1% vs 8.3%;p = 0.5)。随时发烧组的中位发烧负担为303.8 (IQR 138.8-607.9) UTB，死亡率低于随时不发烧组(4.7% vs 11.2%;p = 0.052)。分诊时发烧的患者比没有发烧的患者有更高的SIRS平均标准(2.8 vs 2.0;p < 0.001)，而qSOFA积分相似(p = 0.199)。共有27例患者在急诊科住院期间发生低温症，这些患者年龄较大，平均SIRS标准较高。结论脓毒症和脓毒性休克患者在急诊科有明显的温度负担。通过比较在急诊科住院期间任何时间发烧的患者与从未发烧的患者，发现发烧负担与死亡率呈反比关系。
{"title":"An investigation of temperature and fever burdens in patients with sepsis admitted from the emergency department to the hospital","authors":"Jessica L. Beadle, Sarah M. Perman, Justin Pennington, David F. Gaieski","doi":"10.1002/ams2.902","DOIUrl":"10.1002/ams2.902","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Aim</h3>\u0000 \u0000 <p>We sought to collect granular data on temperature burden to further explore existing conflicting information on the relationship between temperature alterations and outcomes in patients with sepsis requiring hospital admission.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This was a prospective cohort study that enrolled a convenience sample of patients with sepsis or septic shock admitted to the hospital from the emergency department (ED). A “unit of temperature burden (UTB)” was defined as >1°C (1.8°F) above or below 37°C (98.6°F) for 1 min. Fever burden was defined as the number of UTBs >38°C (100.4°F). The primary objective was to calculate the fever burden in patients with sepsis during their ED stay. This was analyzed for patients who present to triage febrile or hypothermic and also for those who developed temperature abnormalities during their ED stay. The secondary objectives were correlating fever and hypothermia burden with in-hospital mortality, Systemic Inflammatory Response Syndrome (SIRS) criteria, and the quick Sequential (Sepsis-Associated) Organ Failure Assessment (qSOFA) score and identification of patients who may benefit from early implementation of targeted temperature management.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>A total of 256 patients met the inclusion criteria. The mean age of patients was 60.1 ± 18.4 years; 46% were female and 29.6% were black. The median (interquartile range [IQR]) fever burden for the fever in triage cohort (<i>n</i> = 99) was 364.6 (174.3-716.8) UTB and for the no fever in triage cohort (<i>n</i> = 157) was 179.3 (80.9-374.0) UTB (p = 0.005). The two groups had similar in-hospital mortality (6.1 vs 8.3%; p = 0.5). The median fever burden for the fever anytime cohort was 303.8 (IQR 138.8-607.9) UTB and they had lower mortality than the no fever anytime cohort (4.7% vs 11.2%; p = 0.052). Patients with fever at triage had higher mean SIRS criteria than those without (2.8 vs 2.0; p < 0.001) while qSOFA points were similar (p = 0.199). A total of 27 patients had hypothermia during their ED stay and these patients were older with higher mean SIRS criteria.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Patients with sepsis and septic shock have a significant temperature burden in the ED. When comparing patients who had fever at any time during their ED stay with those who never had a fever, a trend toward an inverse relationship between fever burden and mortality was found.</p>\u0000 </section>\u0000 </div>","PeriodicalId":7196,"journal":{"name":"Acute Medicine & Surgery","volume":null,"pages":null},"PeriodicalIF":1.6,"publicationDate":"2023-11-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10622605/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"71476952","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
I am writing to provide feedback on the study by Tsuji and colleagues (2023)1 that investigated the association between rapid response system activation and subsequent do-not-attempt-resuscitation (DNAR) orders. While this study enriches our understanding, it also encourages further consideration of the advance care planning (ACP) approach within the evolving decision-making framework.2
The decision to order a DNAR involves complex ethical issues that extend beyond the postcardiac arrest situation.3 Not only do DNAR orders affect prearrest medical interventions, but the timing of these orders also requires careful consideration. There is a balance to be struck: while early orders may deprive patients of potential resuscitative benefits, delaying them may result in missed opportunities. In addition, the scope of the DNAR order itself raises an important question: Does it apply only to cases of underlying disease progression, or does it extend to unexpected cardiac arrests resulting from accidents or abuse? These complexities are exacerbated when elderly patients transition between health care facilities, creating ambiguity in the interpretation of DNAR orders.
This is where the ACP approach needs to be applied. The lack of comprehensive guidelines for DNAR orders contributes to uncertainty. Balancing patient preferences with the potential benefits of resuscitation presents a complex ethical dilemma, and the ACP approach offers a potential solution to such problems. It is a decision-making process that involves a broader perspective than just the DNAR order itself. Through empathic and supportive communication, the ACP approach respects patients’ values and lifestyles, while fostering trust between health care professionals and patients. The ACP approach ensures informed decision making that addresses patients’ concerns about end-of-life care.
The focus will be on incorporating the ACP approach beyond the DNAR instruction itself to the broader decision-making framework.4, 5 This integration is not limited to postcardiac arrest interventions, but will also include decisions made before such critical events. In this context, it is essential to recognize that all patients are vulnerable. Therefore, health care professionals should genuinely accept the suffering that results from this vulnerability. The willingness of health care professionals to engage in difficult yet thoughtful decision-making discussions with patients is of profound importance. This collaborative and compassionate decision making would contribute to patients leading more fulfilling lives.
In conclusion, overcoming the complex ethical issues associated with DNAR orders requires a collaborative effort to expand the ACP approach within a decision-making framework. Reducing the ambiguity surrounding DNAR orders and establishing a resilient decision-making system ar
{"title":"Exploring the ethical complexities of do-not-attempt-resuscitation orders using the approach of advance care planning","authors":"Ryo Ogata, Hiroshi Soda, Yuichi Fukuda, Hiroshi Mukae","doi":"10.1002/ams2.903","DOIUrl":"10.1002/ams2.903","url":null,"abstract":"<p>I am writing to provide feedback on the study by Tsuji and colleagues (2023)<span><sup>1</sup></span> that investigated the association between rapid response system activation and subsequent do-not-attempt-resuscitation (DNAR) orders. While this study enriches our understanding, it also encourages further consideration of the advance care planning (ACP) approach within the evolving decision-making framework.<span><sup>2</sup></span></p><p>The decision to order a DNAR involves complex ethical issues that extend beyond the postcardiac arrest situation.<span><sup>3</sup></span> Not only do DNAR orders affect prearrest medical interventions, but the timing of these orders also requires careful consideration. There is a balance to be struck: while early orders may deprive patients of potential resuscitative benefits, delaying them may result in missed opportunities. In addition, the scope of the DNAR order itself raises an important question: Does it apply only to cases of underlying disease progression, or does it extend to unexpected cardiac arrests resulting from accidents or abuse? These complexities are exacerbated when elderly patients transition between health care facilities, creating ambiguity in the interpretation of DNAR orders.</p><p>This is where the ACP approach needs to be applied. The lack of comprehensive guidelines for DNAR orders contributes to uncertainty. Balancing patient preferences with the potential benefits of resuscitation presents a complex ethical dilemma, and the ACP approach offers a potential solution to such problems. It is a decision-making process that involves a broader perspective than just the DNAR order itself. Through empathic and supportive communication, the ACP approach respects patients’ values and lifestyles, while fostering trust between health care professionals and patients. The ACP approach ensures informed decision making that addresses patients’ concerns about end-of-life care.</p><p>The focus will be on incorporating the ACP approach beyond the DNAR instruction itself to the broader decision-making framework.<span><sup>4, 5</sup></span> This integration is not limited to postcardiac arrest interventions, but will also include decisions made before such critical events. In this context, it is essential to recognize that all patients are vulnerable. Therefore, health care professionals should genuinely accept the suffering that results from this vulnerability. The willingness of health care professionals to engage in difficult yet thoughtful decision-making discussions with patients is of profound importance. This collaborative and compassionate decision making would contribute to patients leading more fulfilling lives.</p><p>In conclusion, overcoming the complex ethical issues associated with DNAR orders requires a collaborative effort to expand the ACP approach within a decision-making framework. Reducing the ambiguity surrounding DNAR orders and establishing a resilient decision-making system ar","PeriodicalId":7196,"journal":{"name":"Acute Medicine & Surgery","volume":null,"pages":null},"PeriodicalIF":1.6,"publicationDate":"2023-10-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10613806/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"71419591","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Shogo Shirane, Hiraku Funakoshi, Jin Takahashi, Yosuke Homma, Tatsuya Norii
Aim
Capnography is recommended for use in procedural sedation and analgesia (PSA); however, limited studies assess its impact on recovery time. We investigated the association between capnography and the recovery time of PSA in the emergency department (ED).
Methods
This study was a secondary analysis of a multicenter PSA patient registry including eight hospitals in Japan. We included all patients who received PSA in the ED between May 2017 and May 2021 and divided the patients into capnography and no-capnography groups. The primary outcome was recovery time, defined as the time from the end of the procedure to the cessation of monitoring. The log-rank test and multivariable analysis using clustering for institutions were performed.
Results
Of the 1265 screened patients, 943 patients who received PSA were enrolled and categorized into the capnography (n = 150, 16%) and no-capnography (n = 793, 84%) groups. The median recovery time was 40 (interquartile range [IQR]: 25–63) min in the capnography group and 30 (IQR: 14–55) min in the no-capnography group. In the log-rank test, the recovery time was significantly longer in the capnography group (p = 0.03) than in the no-capnography group. In the multivariable analysis, recovery time did not differ between the two groups (adjusted hazard ratio, 0.95; 95% confidence interval, 0.77–1.17; p = 0.61).
Conclusion
In this secondary analysis of the multicenter registry of PSA in Japan, capnography use did not associate with shorter recovery time in the ED.
{"title":"Association between capnography and recovery time after procedural sedation and analgesia in the emergency department","authors":"Shogo Shirane, Hiraku Funakoshi, Jin Takahashi, Yosuke Homma, Tatsuya Norii","doi":"10.1002/ams2.901","DOIUrl":"10.1002/ams2.901","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Aim</h3>\u0000 \u0000 <p>Capnography is recommended for use in procedural sedation and analgesia (PSA); however, limited studies assess its impact on recovery time. We investigated the association between capnography and the recovery time of PSA in the emergency department (ED).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This study was a secondary analysis of a multicenter PSA patient registry including eight hospitals in Japan. We included all patients who received PSA in the ED between May 2017 and May 2021 and divided the patients into capnography and no-capnography groups. The primary outcome was recovery time, defined as the time from the end of the procedure to the cessation of monitoring. The log-rank test and multivariable analysis using clustering for institutions were performed.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Of the 1265 screened patients, 943 patients who received PSA were enrolled and categorized into the capnography (<i>n</i> = 150, 16%) and no-capnography (<i>n</i> = 793, 84%) groups. The median recovery time was 40 (interquartile range [IQR]: 25–63) min in the capnography group and 30 (IQR: 14–55) min in the no-capnography group. In the log-rank test, the recovery time was significantly longer in the capnography group (<i>p</i> = 0.03) than in the no-capnography group. In the multivariable analysis, recovery time did not differ between the two groups (adjusted hazard ratio, 0.95; 95% confidence interval, 0.77–1.17; <i>p</i> = 0.61).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>In this secondary analysis of the multicenter registry of PSA in Japan, capnography use did not associate with shorter recovery time in the ED.</p>\u0000 </section>\u0000 </div>","PeriodicalId":7196,"journal":{"name":"Acute Medicine & Surgery","volume":null,"pages":null},"PeriodicalIF":1.6,"publicationDate":"2023-10-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10604570/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"71410120","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Sepsis is the leading cause of death worldwide. Considering regional variations in the characteristics of patients with sepsis, a better understanding of the epidemiology in Japan will lead to further development of strategies for the prevention and treatment of sepsis. To investigate the epidemiology of sepsis, we conducted a systematic literature review of PubMed between 2003 and January 2023. Among the 78 studies using a Japanese administrative database, we included 20 that defined patients with sepsis as those with an infection and organ dysfunction. The mortality rate in patients with sepsis has decreased since 2010, reaching 18% in 2017. However, the proportion of inpatients with sepsis is increasing. A study comparing short-course (≤7 days) and long-course (≥8 days) antibiotic administration showed lower 28-day mortality in the short-course group. Six studies on the treatment of patients with septic shock reported that low-dose corticosteroids or polymyxin B hemoperfusion reduced mortality, whereas intravenous immunoglobulins had no such effect. Four studies investigating the effects of treatment in patients with sepsis-associated disseminated intravascular coagulation demonstrated that antithrombin may reduce mortality, whereas recombinant human soluble thrombomodulin does not. A descriptive study of medical costs for patients with sepsis showed that the effective cost per survivor decreased over an 8-year period from 2010 to 2017. Sepsis has a significant impact on public health, and is attracting attention as an ongoing issue. Further research to determine more appropriate prevention methods and treatment for sepsis should be a matter of priority.
{"title":"Epidemiology of sepsis in a Japanese administrative database","authors":"Taro Imaeda, Takehiko Oami, Nozomi Takahashi, Daiki Saito, Akiko Higashi, Taka-aki Nakada","doi":"10.1002/ams2.890","DOIUrl":"10.1002/ams2.890","url":null,"abstract":"<p>Sepsis is the leading cause of death worldwide. Considering regional variations in the characteristics of patients with sepsis, a better understanding of the epidemiology in Japan will lead to further development of strategies for the prevention and treatment of sepsis. To investigate the epidemiology of sepsis, we conducted a systematic literature review of PubMed between 2003 and January 2023. Among the 78 studies using a Japanese administrative database, we included 20 that defined patients with sepsis as those with an infection and organ dysfunction. The mortality rate in patients with sepsis has decreased since 2010, reaching 18% in 2017. However, the proportion of inpatients with sepsis is increasing. A study comparing short-course (≤7 days) and long-course (≥8 days) antibiotic administration showed lower 28-day mortality in the short-course group. Six studies on the treatment of patients with septic shock reported that low-dose corticosteroids or polymyxin B hemoperfusion reduced mortality, whereas intravenous immunoglobulins had no such effect. Four studies investigating the effects of treatment in patients with sepsis-associated disseminated intravascular coagulation demonstrated that antithrombin may reduce mortality, whereas recombinant human soluble thrombomodulin does not. A descriptive study of medical costs for patients with sepsis showed that the effective cost per survivor decreased over an 8-year period from 2010 to 2017. Sepsis has a significant impact on public health, and is attracting attention as an ongoing issue. Further research to determine more appropriate prevention methods and treatment for sepsis should be a matter of priority.</p>","PeriodicalId":7196,"journal":{"name":"Acute Medicine & Surgery","volume":null,"pages":null},"PeriodicalIF":1.6,"publicationDate":"2023-10-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/ams2.890","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41231572","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Naito T, Fujiwara S, Kawasaki T, Sento Y, Nakada TA, Arai M, Atagi K, Fujitani S; In-Hospital Emergency Study Group. First report based on the online registry of a Japanese multicenter rapid response system: a descriptive study of 35 institutions in Japan. Acute Med Surg. 2019; 7(1):e454.
In Table 2, the count for “Neurology” is currently listed as “1532 (26.0%)”. This is incorrect. The correct number should be “1789 (30.4%)”.
We apologize for this error.
[这更正了文章DOI:10.1002/ams2.454.]。
{"title":"Correction to “First report based on the online registry of a Japanese multicenter rapid response system: A descriptive study of 35 institutions in Japan”","authors":"","doi":"10.1002/ams2.900","DOIUrl":"10.1002/ams2.900","url":null,"abstract":"<p>Naito T, Fujiwara S, Kawasaki T, Sento Y, Nakada TA, Arai M, Atagi K, Fujitani S; In-Hospital Emergency Study Group. First report based on the online registry of a Japanese multicenter rapid response system: a descriptive study of 35 institutions in Japan. Acute Med Surg. 2019; 7(1):e454.</p><p>In Table 2, the count for “Neurology” is currently listed as “1532 (26.0%)”. This is incorrect. The correct number should be “1789 (30.4%)”.</p><p>We apologize for this error.</p>","PeriodicalId":7196,"journal":{"name":"Acute Medicine & Surgery","volume":null,"pages":null},"PeriodicalIF":1.6,"publicationDate":"2023-10-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/ams2.900","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41231571","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
To determine whether the rewarming rate is associated with neurological outcomes in patients with post–cardiac arrest syndrome treated with targeted temperature management (TTM) at 34°C.
Methods
We conducted a retrospective analysis of a nationwide cohort study of out-of-hospital cardiac arrest in Japan. Adult patients who experienced a return of spontaneous circulation and completed TTM at 34°C between June 2014 and December 2019 were divided equally into three groups (slow, moderate, and rapid) according to their rewarming rates from 34°C to 36°C. The rates of favorable neurological outcomes (Cerebral Performance Category of 1–2 after 30 days) were compared among the groups, and the adjusted odds ratios for a favorable neurological outcome were calculated for the groups.
Results
We analyzed 348, 357, and 358 patients in the slow, moderate, and rapid groups, respectively. The periods of rewarming from 34°C to 36°C were 41.9 ± 10.5, 22.4 ± 1.8, and 12.2 ± 3.6 h, respectively. The number of favorable neurological outcomes after 30 days was 121 (34.8%), 125 (35.0%), and 147 (41.1%), respectively, with no significant differences among the three groups (p = 0.145). Rapid rewarming was independently associated with a favorable neurological outcome compared with slow rewarming (adjusted odds ratio 1.57 [95% confidence interval 1.04–2.37]; p = 0.031).
Conclusions
Rapid rewarming after TTM at 34°C was associated with a more favorable neurological outcome than slow rewarming.
{"title":"Rapid rewarming rate associated with favorable neurological outcomes in patients with post–cardiac arrest syndrome patients treated with targeted temperature management","authors":"Masaru Shin, Motoki Fujita, Toru Hifumi, Yasutaka Koga, Takeshi Yagi, Takashi Nakahara, Masaki Todani, Kotaro Kaneda, Ryosuke Tsuruta","doi":"10.1002/ams2.897","DOIUrl":"10.1002/ams2.897","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Aim</h3>\u0000 \u0000 <p>To determine whether the rewarming rate is associated with neurological outcomes in patients with post–cardiac arrest syndrome treated with targeted temperature management (TTM) at 34°C.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We conducted a retrospective analysis of a nationwide cohort study of out-of-hospital cardiac arrest in Japan. Adult patients who experienced a return of spontaneous circulation and completed TTM at 34°C between June 2014 and December 2019 were divided equally into three groups (slow, moderate, and rapid) according to their rewarming rates from 34°C to 36°C. The rates of favorable neurological outcomes (Cerebral Performance Category of 1–2 after 30 days) were compared among the groups, and the adjusted odds ratios for a favorable neurological outcome were calculated for the groups.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>We analyzed 348, 357, and 358 patients in the slow, moderate, and rapid groups, respectively. The periods of rewarming from 34°C to 36°C were 41.9 ± 10.5, 22.4 ± 1.8, and 12.2 ± 3.6 h, respectively. The number of favorable neurological outcomes after 30 days was 121 (34.8%), 125 (35.0%), and 147 (41.1%), respectively, with no significant differences among the three groups (<i>p</i> = 0.145). Rapid rewarming was independently associated with a favorable neurological outcome compared with slow rewarming (adjusted odds ratio 1.57 [95% confidence interval 1.04–2.37]; <i>p</i> = 0.031).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Rapid rewarming after TTM at 34°C was associated with a more favorable neurological outcome than slow rewarming.</p>\u0000 </section>\u0000 </div>","PeriodicalId":7196,"journal":{"name":"Acute Medicine & Surgery","volume":null,"pages":null},"PeriodicalIF":1.6,"publicationDate":"2023-10-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/ams2.897","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41231573","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
We describe a case of segmental arterial mediolysis in which a vessel ruptured on two consecutive days.
Case Presentation
A 69-year-old man presented with sudden-onset abdominal pain. Computed tomography showed a hematoma in the gastric wall. The patient was discharged after the pain was relieved but returned 8 h later with abdominal pain and shock. Repeated computed tomography revealed a massive intra-abdominal hemorrhage without previous aneurysm formation. Emergency angiography and coil embolization were successfully carried out. Segmental arterial mediolysis was diagnosed after irregular vasodilated lesions were observed in multiple arteries.
Conclusion
This case suggests that accurately predicting the next vessel rupture is difficult. For patients experiencing intra-abdominal bleeding with segmental arterial mediolysis, we suggest treating only ruptured aneurysms and closely following-up unruptured aneurysms.
{"title":"Segmental arterial mediolysis with a ruptured visceral artery on two consecutive days","authors":"Chikao Ito, Tomohide Koyama, Daisuke Fujimori, Isao Takahashi, Miyuki Kasuya, Kyoji Oe, So Sakamoto, Ryuhei Yoshida, Hidetaka Yoshiike, Masaaki Ito, Wataru Yamashita, Sho Watanabe, Jun Isogai","doi":"10.1002/ams2.899","DOIUrl":"10.1002/ams2.899","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>We describe a case of segmental arterial mediolysis in which a vessel ruptured on two consecutive days.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Case Presentation</h3>\u0000 \u0000 <p>A 69-year-old man presented with sudden-onset abdominal pain. Computed tomography showed a hematoma in the gastric wall. The patient was discharged after the pain was relieved but returned 8 h later with abdominal pain and shock. Repeated computed tomography revealed a massive intra-abdominal hemorrhage without previous aneurysm formation. Emergency angiography and coil embolization were successfully carried out. Segmental arterial mediolysis was diagnosed after irregular vasodilated lesions were observed in multiple arteries.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>This case suggests that accurately predicting the next vessel rupture is difficult. For patients experiencing intra-abdominal bleeding with segmental arterial mediolysis, we suggest treating only ruptured aneurysms and closely following-up unruptured aneurysms.</p>\u0000 </section>\u0000 </div>","PeriodicalId":7196,"journal":{"name":"Acute Medicine & Surgery","volume":null,"pages":null},"PeriodicalIF":1.6,"publicationDate":"2023-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/1f/cb/AMS2-10-e899.PMC10560134.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41181770","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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