Introduction: The PICU of our facility initiated measures for enhancing early rehabilitation for critically ill children in 2013. This study examined the efficacy of these measures and identified related problems. Subjects and methods: We investigated that the efficacy and implementation rate of early rehabilitation for children <16 years old who stayed in the PICU more over 3 days, and PICU physicians' and nurses' awareness and knowledge for early rehabilitation. Results: The efficacy of early rehabilitation for critically ill children was unable to be verified. The lack of efficacy was attributed to a low implementation rate and level of knowledge regarding early rehabilitation, evaluation methods of the efficacy, as well as the fact that systems for cooperation with physical therapists had not been established. Discussion: In the future, it is necessary to evaluate the efficacy of rehabilitation based on the matrics corresponding age and development of children for each age, disease, and severity.

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Objectives: To evaluate the usefulness of procalcitonin (PCT) in differential diagnosis for bacteremia or blood culture contamination and predicting either Gram-positive or Gram-negative bacteremia. Methods: We retrospectively reviewed a total of 132 cases in which PCT and C-reactive protein (CRP) were examined and blood cultures were found to be positive from November 2012 to June 2013. Results: The PCT concentrations were significantly higher in bacteremia cases (n=102) than in contamination cases (n=30) (median: 2.8 ng/ml vs. 0.3 ng/ml, P<0.001). The receiver operating characteristics-areas under the curve (ROC-AUCs) of PCT and CRP for discriminating bacteremia from contamination were 0.76 and 0.64, respectively. PCT concentrations of Gram-positive cases (n=48) were not significantly different from those of Gram-negative cases (n=54) (median: 2.1 ng/ml vs. 3.7 ng/ml, P=0.123). Conclusions: Compared with CRP, PCT could be useful in the differential diagnosis between bacteremia and contamination. However, we may not estimate either Gram-positive or Gram-negative bacteremia using CRP and PCT.

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Tetanus can rapidly develop into muscle spasm accompanied by respiratory failure and result in fatal outcomes. Although the management of muscle spasticity and rigidity is of great importance, there is no consensus on the best treatment modality. Recently, the herbal medicine shakuyakukanzoto has been reported to be effective for the treatment of the muscle disorder in 2 patients with tetanus. Here, we report a comparison of 3 cases of tetanus that were successfully treated with shakuyakukanzoto with 3 cases treated without shakuyakukanzoto. All patients with tetanus presented with neck stiffness, dysphagia, and trismus, and received intravenous anti-tetanus human immunoglobulin and penicillin G with or without the oral administration of shakuyakukanzoto. Improvements in muscle spasticity and rigidity were found only in patients with shakuyakukanzoto, and not in those treated without: the latter needed to be managed with mechanical ventilation. Shakuyakukanzoto may be useful for the treatment of muscle spasticity and rigidity in patients with tetanus.

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Objective: To investigate outcomes of patients with mycotic thoracic aortic aneurysm treated with thoracic endovascular aortic repair (TEVAR) in our hospital. Material and methods: Between March 2012 and November 2013, 5 patients underwent TEVAR. We analyzed bacterial culture results, rates of perioperative complications and mortality. Results: Five patients (3 men, 2 women) had a mean age of 79.6 years (range, 61-98 years). There were no cases with fistula formation between the aorta and the intestine or bronchi. After the diagnosis was made, all patients empirically received broad-spectrum antibiotics. All the patients immediately underwent TEVAR. On blood culture, Bacteroides fragilis, methicillin-sensitive Staphylococcus aureus, penicillin-resistant Streptococcus pneumoniae, Escherichia coli, and Streptococcus agalactiae were identified. Thereafter, specific antibiotic treatment was administered according to culture and susceptibility results and was continued for 6 weeks. The antibiotic treatment was then changed from intravenous to oral form and was continued indefinitely. The postoperative complications included incisional hernia in one case and thoracic hematoma in another case. All the patients remained alive throughout the follow-up duration (mean duration, 15.2 months; range, 7-29 months).

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For rapid and safe extracorporeal cardiopulmonary resuscitation (ECPR) induction without using a fluoroscope, we cannulated the right internal jugular vein for outflow in out-of-hospital cardiac arrest patients. Four patients underwent ECPR (average time from arrival to initiation of extracorporeal membrane oxygenation (ECMO) [minimum-maximum], 19.5 min [16-23 min]; and ECMO pump flow, 2.5 l/min [1.2-3.7 l/min]). There were no complications associated with ECMO induction (massive bleeding, ischemia, infection, or misplacement). Sufficient ECMO pump flow was obtained before return of spontaneous circulation (ROSC). We relocated the blood outflow cannula site to the femoral vein in one patient due to a low flow rate after ROSC. Two out of four patients were weaned from ECMO. One patient survived without a neurologic deficit; the other three patients died. Right internal jugular vein cannulation (outflow) provided rapid and safe induction of ECPR in out-of-hospital cardiac arrest patients when a fluoroscope was not available. However, there was some limitation in the flow rate after ROSC.

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[in Japanese]

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[in Japanese]

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[in Japanese]

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