Pregnancy-related critical illness and death are important global causes of morbidity and mortality. In the developed world, although rates have fallen substantially over the past century, maternal mortality remains at around 10/100,000 live births. For each maternal death, nine women develop severe maternal morbidity or critical illness, accounting for approximately 1.5% of the admissions to ICU. Major reasons underlying ICU admission include: pregnancy induced hypertension syndrome, obstetric hemorrhage and pregnancy-related sepsis, collectively accounting for approximately 70% of all ICU admissions. There are also physiological changes during pregnancy that influence both the likelihood of becoming critically ill, and the manner in which patients are treated. Similarly, it is important to understand the influence of maternal critical illness on the fetus, and how treatment strategies for the mother influence fetal outcome.

View full abstract

Multi-disciplinary team practice is more important in the ICU than in general wards, and pharmacists are essential member of the team. Moreover, the Ministry of Health, Labour and Welfare has announced that the role of pharmacists in the ICU should include not only management of drugs but also active involvement in treatment plans. With this in mind, we have reviewed the literature concerning the need of pharmacist participation in the ICU. It has been reported in multiple studies that pharmacist involvement in patient care activities in the ICU is related to medical cost saving, reduced medication errors and reduced mortality. The results of these studies suggest that pharmacists might be able to not only contribute to decreased medical expenditure but also have a positive impact on appropriate prescribing of medications and patient outcome. In Japan, if pharmacists become essential members of ICU teams and are actively involved in daily practice, their impact could be significant.

View full abstract

Objectives: The present study investigated whether an immuno-modulating enteral diet (IMD) enriched with eicosapentaenoic acid, γ-linolenic acid, and antioxidants, evaluated to be effective in foreign countries, would be efficacy for Japanese patients with severe sepsis/septic shock requiring mechanical ventilation. Patients: The study enrolled 70 patients with severe sepsis/septic shock requiring mechanical ventilation in 10 university hospitals in Japan. Methods: Patients were randomized into two groups by the envelop system: continuously tube-fed with either the IMD (IMD group) or an isonitrogenous and isocaloric control diet (control group). The oxygenation status and Sequential Organ Failure Assessment score of the patients, blood levels of C-reactive protein (CRP) and prothrombin time international normalized ratio (PT-INR), ventilator free-days and ICU-free days, and survival rate were compared between the two groups. Results: Blood level of CRP on 14^th day in the IMD group significantly improved compared with that of the control group. Furthermore, the levels of PT-INR in the IMD group on 4^th and 7^th day were significantly higher than those of the control group. Conclusion: The efficacy of IMD useful for Japanese patients should be investigated with the larger randomized controlled trial (RCT).

View full abstract

Pyruvate dehydrogenase complex (PDHC) is a critically important enzyme for energy production. Hence, disorders related to this enzyme can lead to lactic acidosis. Here, we report a case wherein the patient had a disorder of the PDHC leading to intractable lactic acidosis, and acute blood purification proved to be a useful treatment option. The patient was a 3-year-old girl who was admitted to the intensive care unit because she had developed severe lactic acidosis with disturbed consciousness. Although she immediately received continuous purification therapy, she did not show improvement in the lactic acidosis. Subsequently, we increased the dialysis flow rate, leading to successful reduction of the blood lactate level. Hemodiafiltration was discontinued, but the patient did not gain consciousness because she had already developed a cerebral disorder, which was considered to be due to the lactic acidosis. The clinical course of this case suggests that continuous blood purification with a high dialysis flow rate would be useful for the treatment of intractable lactic acidosis. A review of cases, such as the one presented here, would provide some useful information for determining the best setting for acute blood purification therapy in pediatric cases.

View full abstract

A 50-year-old man with acute amphetamine intoxication was admitted to the ICU. Fourteen days following admission, the patient showed respiratory distress with diffuse pulmonary infiltration. A diagnosis of alveolar hemorrhage was made from bloody fluid collected by bronchoalveolar lavage. He recovered fully following 5-day administration of methylpredonisolone. Although there are many reports about vascular complications associated with amphetamine abuse, this may be the first case report about acute amphetamine intoxication complicated with alveolar hemorrhage. This report contains several discussions about possible vasculopathy associated with amphetamine intoxication.

View full abstract

Objectives: To evaluate the impact of introducing a high intensity physician staffing model in an academic center in Japan on patient outcome. Methods: Adult patients who stayed in the ICU for longer than 2 days between April 2005 and September 2008 were studied. Patient demographics were collected from our ICU database. Patients were divided into two groups: before (Period 1) and after (Period 2) January 2007, when the high intensity model was implemented in the ICU. Results: Five hundred and twelve patients in Period 1 and 563 patients in Period 2 were included in the study. A multivariate analysis for all study patients showed that Period 2 was significantly related to lower hospital mortality (odds ratio 0.62, P=0.040). Conclusions: It is possible that the high intensity physician staffing model contributed to better patient outcomes.

View full abstract

Using a self-administered questionnaire, we compared the prevalence of complicated grief in family members of patients who had died in the emergency department (n=49) or ICU (n=156) and those of patients who had died in the general ward (n=432). Participants were community-dwelling individuals (aged 40-79 years) who had experienced bereavement within the past 10 years. Complicated grief was assessed using the brief grief questionnaire. There were 3 (6%) emergency-department-bereaved, 5 (3%) ICU-bereaved, and 10 (2%) general ward-bereaved individuals with complicated grief, while 11 (22%), 37 (24%), and 99 (23%) in these groups had subthreshold complicated grief, respectively. Thus, prevalence of complicated grief did not significantly differ between groups. The emergency- and ICU-bereaved showed significant differences from the general ward-bereaved in cause of death and whether the death was expected. These results imply that these two variables did not affect prevalence.

View full abstract

[in Japanese]

View full abstract