Objectives: To evaluate the interrater reliability of a modified Japanese version of State Behavioral Scale (SBS). Methods: We translated SBS into Japanese and partly modified the item regarding spontaneous breathing. The sedation status of pediatric patients aged < 16 years who were mechanically ventilated in our pediatric ICU was evaluated using the modified Japanese version of SBS. The scores were measured by a bedside nurse and an in-charge nurse or a physician, and the interrater reliability of the scores was analyzed using the weighted κ statistic. Results: A total of 63 sets of observations were made for 10 patients. With regard to interrater reliability, the weighted κ coefficient of modified Japanese version of SBS scores was 0.57. The weighted κ coefficient of the each element of the modified Japanese version of SBS was as follows: 0.78 (spontaneous breathing), 0.56 (coughing), 0.59 (best response to stimulation), 0.21 (attentiveness to care provider), 0.56 (tolerance to care), 0.61 (consolability), 0.60 (movement). Conclusions: The interrater reliability of the modified Japanese version of SBS scores was moderate. One element constituting the scale had a low rate of agreement. Our results suggest that further modification of the scale and reevaluation are necessary.

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Objective: We studied the trending ability and the correlation between central venous oxygen saturation (ScvO₂) and mixed venous oxygen saturation (SvO₂); they were measured concurrently by spectrophotometry. The purpose of this study was to determine whether ScvO₂ could be exploited as a hemodynamic monitor after the removal of a pulmonary artery catheter. Methods: After arrival at the ICU, we measured and recorded ScvO₂ and SvO₂ continuously. We selected the pairs of ScvO₂ and SvO₂, which showed a value of 1 or 2 on signal quality indicator, and examined the trending ability and the correlation between the two. Results: The data of 24 adult patients who underwent cardiac surgery were examined. As the result, the range of the coefficient of correlation was 0.12-0.85 and showed great dispersion between cases. And individual case had different bias. It was only 2 cases to have shown good trending ability. Conclusions: Since the correlation between ScvO₂ and SvO₂ were different by cases respectively and there were few cases showing good trending ability, we should regard ScvO₂ as a hemodynamic index which was different from SvO₂.

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We describe a pediatric case of life-threatening asthma refractory to conventional therapies in which sevoflurane enabled adequate mechanical ventilation. However, despite improved peak inspiratory pressures, secretion retention and poor oxygenation remained. The combined use of intrapulmonary percussive ventilation (IPV) and prone positioning (PP) was effective in improving these manifestations. The use of inhalational anesthetics combined with IPV and PP may have life-saving effects in cases of life-threatening asthma.

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We report a case of intramural esophageal dissection caused by the feeding tube, which is a rare complication of feeding tube insertion. A 19-year-old woman was transferred to our hospital in cardiopulmonary arrest following a traffic accident. After spontaneous circulation returned, she was admitted to the ICU in a comatose condition. A feeding tube was inserted orally, and the tube location was confirmed via X-rays and the auscultatory method. On the fourth hospital day, pneumomediastinum appeared on chest X-ray. Upper gastrointestinal endoscopy revealed that the feeding tube had caused intramural esophageal dissection, descending within the esophageal wall and then returning back into the stomach at the gastric cardia. The feeding tube was immediately removed, at which point the intramural esophageal dissection spontaneously resolved. Intramural esophageal dissection may be difficult to detect via standard methods when the tip of the feeding tube returns inside the gastrointestinal tract. Patients with feeding tubes should undergo careful observation even after enteral nutrition is started.

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