Difficult airways and severe airway-related adverse events occur much more commonly in emergency departments and ICUs than in operating rooms. Thus, rescue ventilation strategies are indispensable in emergency departments and ICUs. Rescue ventilation techniques in time-sensitive situations must be fast, simple and easy to perform. Considering this situation, supraglottic airway devices are near-ideal instruments. Using a supraglottic airway device is a common first-line rescue ventilation strategy in difficult airway management (DAM) algorithms advocated by several professional anesthesiology societies. Furthermore, supraglottic airway devices are also proving to be useful for DAM in emergency departments and ICUs, and evidence supporting their implementation in such environments is increasing. However, supraglottic airway devices are much less likely to be available in Japanese emergency medical services and ICUs than in other countries. Immediate access to appropriate DAM devices, including supraglottic airways, is essential to ensure safety. The aim of this study was to reappraise the role of supraglottic airway devices in the field of emergency and critical care medicine.

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Objective: The aim of the study is to investigate the association of pre-, intra- and postoperative factors with the development of delirium after cardiovascular surgery. Methods: Expected factors for postoperative delirium were studied in 88 patients (65.6±11.9 years) underwent elective cardiovascular surgery. Hospital anxiety and depression scale (HADS), mini-mental state examination (MMSE), ability to perform activities of daily living and length of hospital stay before surgery were examined as preoperative factors of delirium. Body water balance during and after surgery, length of stay in an ICU and length of hospital stay after surgery were also monitored as intra- or postoperative factors. The presence of the delirium was assessed using the Japanese version of the CAM-ICU (confusion assessment method for the ICU). Results: Delirium was presented in 11 of 88 patients (12.5%). Patients with delirium showed statistically high HADS scores (P=0.003), low MMSE scores (P=0.031), large body water volume (P=0.030) and long ICU stay (P=0.022). Moreover, logistic analysis identified length of stay in ICU and HADS-depression scores as factors related to delirium after cardiovascular surgery. Conclusions: Our results suggested that high level of depression, low cognitive state and large body water volume were related to delirium after cardiovascular surgery.

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Objectives: In this retrospective study, we examined the clinical course of severe sepsis in patients with DIC who received recombinant human thrombomodulin (rTM) therapy, and compared the differences between survivors and non-survivors. Methods: The study cohort included 17 patients diagnosed with severe sepsis and DIC score between September 1, 2013 and May 31, 2014, in whom rTM therapy was initiated. Evaluation of DIC was completed using the DIC diagnostic criteria of the Japanese Association for Acute Medicine. We examined characteristics of the patients including SOFA score at admission; the time interval between diagnosis of DIC and initiation of rTM therapy; and the changes in DIC score at 1, 3, and 7 days after initiation of rTM therapy, and compared the differences in these parameters between survivors and non-survivors. Results: There were no significant differences regarding the severity of illness between survivors (n=13) and non-survivors (n=4) at intensive care unit admission (SOFA score: 11.1±3.3 vs. 10.8±3.0; mean±SD). The time interval between diagnosis of DIC and initiation of rTM therapy was significantly longer in non-survivors, compared with that for survivors (3 [0-4] vs. 0 [0-1] days; median [range] days). In survivors, the DIC score significantly improved 7 days after initiation of rTM therapy, compared to their score on the first day (1 [1-4] vs. 5 [5-6]; median [range] ). In contrast, in non-survivors, this value did not change significantly (6 [5-7] vs. 8 [7.25-8], median [range] ) by day 7. Conclusion: These results suggest that the prognosis of patients with DIC and severe sepsis will improve with the early initiation of rTM therapy, and an improved DIC score will be observed by 7 days after initiation of therapy.

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[in Japanese]

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