Search

The successful use of prolonged (ie,28 days) veno-venous extracorporeal membrane oxygenation (V-V ECMO) is being increasingly reported. However, limited data are available on its outcomes. This study investigated the outcomes of acute respiratory distress syndrome (ARDS) patients on prolonged ECMO support. We retrospectively evaluated 57 patients requiring V-V ECMO for ARDS between 2015 and 2020. The patients were divided into two groups according to ECMO duration: (a) ≤28 days group (n = 43, 75%) or (b)28 days (n = 14, 25%) group. Clinical characteristics, complications, and outcomes between these two groups were statistically compared. There were no significant differences in demographics, comorbidity, ARDS etiology, and severity scores between the two groups. However, the mechanical ventilation period before ECMO initiation was significantly longer in the28 days group than in the ≤28 days group (10.5 days vs. 1 day; P.05). The incidence of positive bacterial blood culture results during ECMO was significantly higher in the28 days group than in the ≤28 days group (43% vs. 9%; P.05). Additionally, the hospital survival rate was significantly lower in the28 days group than in the ≤28 days ECMO group (21% vs. 60%; P.05). Prolonged ECMO was associated with worse hospital survival outcomes. Early initiation of ECMO along with meticulous care and appropriate treatment against infection during ECMO could improve the hospital survival of ARDS patients on prolonged ECMO support.

Introduction: Oxygenator exchange during extracorporeal membrane oxygenation (ECMO) is a life-threatening procedure. D-dimer has been used to predict oxygenator failure, but it is a parameter used a few days before oxygenator exchange. This study investigated parameters before and immediately after ECMO initiation that predict oxygenator exchange. Methods: This was a single-center, retrospective study of 28 patients who received veno-venous ECMO with heparin/silicone-coated polypropylene oxygenator (NSH-R HPO-23WH-C; Senko Medical Inc., Tokyo, Japan), due to acute respiratory failure, from April 2015 to March 2020. Clinical data before ECMO initiation and during the first 3 days on ECMO were compared between the patients with oxygenator exchange (exchange group) and those without oxygenator exchange (non-exchange group). Results: Nine (32%) patients required oxygenator exchange. The exchange group had significantly higher white blood cell count (WBC) (16,944 ± 2423/µL vs 10,342 ± 1442/µL, p 2 outlet) and activated partial thromboplastin time (aPTT) during the first 3 days on ECMO were significantly lower in the exchange group than in the non-exchange group. Conclusions: High WBC and APACHE II score before ECMO initiation, low PO2 outlet, and aPTT during the first 3 days on ECMO were associated with oxygenator exchange during veno-venous ECMO. These parameters could be used to avoid unexpected oxygenator exchange.

Intravascular lymphoma is a rare disease that progresses to multiple organ dysfunction caused primarily by tumor cell proliferation in small blood vessels. Few studies have investigated critical care management of intravascular lymphoma. We describe a rare case of multiple organ failure due to intravascular lymphoma with severe lactic acidosis in a patient who survived. A 64-year-old man with impaired consciousness was diagnosed as having intravascular large B-cell lymphoma by means of a random skin biopsy. The patient arrived at our hospital's intensive care unit (ICU) with impaired consciousness, respiratory failure that required mechanical ventilation, and lactic acidosis that required renal replacement therapy. Mechanical ventilation and renal replacement therapy were continued in the ICU, and his respiratory status and circulatory dynamics eventually stabilized. However, his impaired consciousness and hyperlactatemia did not improve until after the start of chemotherapy with doxorubicin, cyclophosphamide, vincristine, prednisolone, and rituximab. Although he developed tumor lysis syndrome immediately after chemotherapy, his systemic condition was gradually stabilized by continued critical care management primarily comprising renal replacement therapy. He was weaned from ventilator support after a tracheotomy and moved to the general ward. Hematopoietic malignancy with hyperlactatemia has a very poor prognosis; however, hyperlactatemia and impaired consciousness were dramatically improved in this patient by critical care management and chemotherapy.

Background Intraoperative neuromonitoring (IONM) might reduce the incidence of injury to the recurrent laryngeal nerve (RLN) during thyroidectomy. Although dislocation of endotracheal tube surface electrodes can lead to false-positive IONM results (loss of signal), the risk factors for dislocation and the effects of muscle relaxants are unclear. Therefore, to identify factors that affect IONM results, we examined the frequency and risk factors for tube dislocation after cervical extension before surgery, the effect of sugammadex administration, and the correlation between IONM results and postoperative RLN palsy. Methods Thirty-nine patients scheduled for thyroidectomy from October 2016 to April 2017 were enrolled. All patients underwent standard IONM and pre- and postoperative laryngoscopy. Differences in patient characteristics in the tube dislocation group and non-dislocation group, and differences in amplitude during vagal stimulation before and after sugammadex administration, were assessed by the Mann-Whitney test or Fisher's exact test. Results Tube dislocation occurred in 27 patients (69%). Sterno-cricoid distance was significantly shorter in the dislocation group (n=27) than in the non-dislocation group (n=12) (43.88 [32.2-55.91] mm vs 49.46 [40.66-55.91] mm, respectively; p=0.048). Without sugammadex, amplitude during vagal stimulation was sufficient for monitoring. Nine patients had new-onset RLN palsy, which was transient in all patients. The sensitivity of IONM was 100%, the positive predictive value was 60%, and the negative predictive value was 100%. Conclusions The present findings suggest that anesthesiologists should use video laryngoscopy to correct tube dislocation and that a rocuronium dose of 0.6 mg/kg, without sugammadex, is adequate for IONM.

近年の水道事業体における財政事情の悪化や施設の経年化を背景に，膨大な投資が必要な水道施設の耐震化やその他の震災対策が十分に進捗していない事業体が多い．震災対策を推進していくにあたっては，料金負担者である住民の理解が必要である．本研究では，水道の震災対策事業に関する住民意識を把握するため，大阪市民を対象に，震災によるリスクを提示したアンケート調査を行った．その結果，震災時の断水受忍限度が一番短い使用用途はトイレであり，また，震災対策に対するWTP（支払意志額）は現状の震災対策費用より高く，住民は水道事業体にさらなる震災対策の推進を望んでいる傾向が明らかとなった．なお，支払意志額と情報提供の有無等アンケートの質問項目との有意差が認められなかったため，震災対策推進のためのリスクコミュニケーションの手法等について検討する必要がある．