Pain management is essential for patients with trauma. Stress responses caused by pain are associated with various adverse events, and adequate pain management is associated with good outcomes, both short and long term. Pain should be evaluated using pain assessment tools and analgesia should be systematically performed. Using a multimodal analgesia management strategy that combines various analgesic techniques is effective and can reduce side effects from opioids. In patients with severe trauma, resuscitation must be prioritized; therefore, patients arriving in the intensive care unit should be checked for missed injuries. Rib fracture is common in patients with trauma but can become a lethal condition in the presence of pneumonia because of inappropriate pain management. However, with respect to evidence-based effective analgesic methods, research remains insufficient, and further study is needed.

Objective: The aim of our study was to assess the health-related QOL (HRQOL) recovery of trauma patients 12 months after injury and identify predictive factors associated with improved physical function (PF) and mental health (MH) over time. Methods: A prospective cohort study was performed in our tertiary care hospital from September 2013 to September 2015. All consecutive trauma patients admitted to our department were included in the study. We collected SF-36, injury characteristics, acute care factors, and social status of each patient. Linear mixed-effects models were used to identify factors associated with MH and PF in the SF-36, 12 months after injury. Results: During the study period, complete data was collected for 129 out of 187 patients. Lower-extremity injury [AIS (abbreviated injury scale)≧3], delirium, and living with family, were predictive factors of lower PF, and a married status was associated with lower MH score. However, injury severity score (ISS) and surgical procedure were not predictive factors associated with either PF or MH. Conclusion: The median scores of PH and MH 12 months after injury were lower than Japanese standard norms. Social status, and localization of injured body region, had a stronger effect on long-term HRQOL.

A 59-year-old man was brought to our hospital in an ambulance complaining of abdominal pain. Abdominal contrast CT revealed retroperitoneal hematoma due to the rupture of the an anterior inferior pancreaticoduodenal artery aneurysm. It is highly possible that segmental arterial mediolysis and stenosis of the celiac trunk were associated with the aneurysm. We performed transcatheter arterial embolization for hemostasis, but the patient developed a complication of abdominal compartment syndrome due to a large retroperitoneal hematoma. After open abdominal management using mesh-mediated fascial traction with negative pressure wound therapy, we performed the removal of the retroperitoneal hematoma and definitive fascial closure. The postoperative course went well, and the patient became ambulatory and was discharged.

Objective: The hemolytic uremic syndrome (HUS) is one of the major causes of acute kidney injury (AKI) in childhood. Although some authors have described risk factors for severe course or poor prognosis of renal function in HUS, there were no studies investigated prognostic factors associated with duration of renal replacement therapy (RRT). In this study, we investigated characteristics of patients who required long-term RRT comparing patients who did RRT within one week. Methods: We reviewed the medical record of 7 patients admitted to the PICU with HUS and treated with RRT between January 2010 and December 2014. We divided patients into the short-term group, who required RRT within 1 week, and the long-term group, who needed RRT more than 1 week. We compared the two groups characteristics, laboratory data, urine output and fluid balance. Results: Urine output was lower in the long-term group compared to the short-term group on Day 2 to 4 after starting RRT. %fluid overload was not statistically different between two groups in the same period. Conclusion: Pediatric patients with HUS, who continued to have anuria or oliguria for more than four days after initiating RRT, may need long-term RRT.

Human parechovirus (HPeV) can cause severe infection in newborns and infants that may lead to organ failure. We summarize the clinical features of 13 patients with HPeV infection who were admitted to the PICU at a tertiary children’s hospital in Japan from January 2011 to September 2014. HPeV was confirmed by polymerase chain reaction testing of serum specimens. Important clinical characteristics were male sex (11 of 13 cases were boys), an age of less than three months, and all cases acquired this disease from early summer to early autumn. Typical blood test findings included low white blood cell counts and negative C-reactive proteins. Serum ferritin levels were evaluated in five cases, which were all elevated. In addition, the majority of cases (10 cases) presented with shock, to whom 100 mL/kg or more of intravenous fluid was given. This study revealed that severe cases of HPeV infection in infancy with septic shock required a large amount of intravenous fluid and administration of catecholamine.

Purpose: This study aimed to determine whether use of a national early warning score (NEWS) prior to transfer may serve as a predictor of unplanned readmission to the ICU. Methods: All patients discharged from our hospital high care unit (HCU) from April 2015 through March 2016 were included for analysis. We investigated patient characteristics, NEWS, and unplanned readmission, using electronic patient records. NEWS was immediately recorded before HCU discharge. Results: Among 775 patients included during the study period, there were 24 (3.1%) unplanned readmissions during their hospitalization. Unplanned readmission to the ICU was associated with a higher NEWS than that for non-readmissions (4 vs. 2; P=0.01). There were more patients with a high NEWS who had unplanned ICU readmission than those who were not readmitted (25% vs. 5.6%; OR 4.28, 95%CI 1.38-13.3; P=0.001), but turned out not to be statistically different [AUC (area under the curve) 0.653]. Conclusions: NEWS at HCU discharge can be a useful tool for predicting unplanned readmission.

Background: Dexmedetomidine (DEX) is a potent and highly selective agonist of the α₂-adrenoceptor. Recent studies suggested that platelet-derived microparticles (PMPs) have procoagulant activity that was released from activated platelet membranes and might be involved in thrombogenesis. In the present study, we examined the effects of DEX on PMP generation in human platelets by flow cytometry. Methods: Platelet rich plasma was prepared from healthy male volunteers who had not taken any medication for at least for two weeks before blood collection. The platelet rich plasma was placed at room temperature for 30 min with or without DEX (1, 10, 100 ng/mL) without any stimulant ligands in the presence or absence of yohimbine (10μM), an α₂-antagonist. PMPs were identified using flow cytometry by forward and side scatter intensity and by CD61 and Annexin V expression, and the percentage of PMP counts in platelets was calculated. All data were compared with one-way analysis of variance (ANOVA), followed by Dunnett’s post hoc test. A P value less than 0.05 indicates statistical significance. Result: DEX (10, 100 ng/mL) increased PMP generation in a dose-dependent manner, and this effect was abolished by yohimbine. Discussion: Previously we reported that DEX has both enhancing and suppressing effects on human platelet functions via the α₂-adrenoceptor and imidazoline 1-receptor, respectively. Although DEX enhanced platelet aggregation and P-selectin expression, its effects on PMP generation have not been examined. In this study, we found that DEX promoted PMP generation, and this response was abolished by yohimbine, indicating that DEX increases PMP generation via the α₂-adrenoceptor. Although our study was performed in vitro, and the concentration of DEX that affected PMP generation was apparently higher than the usual therapeutic concentration range (<1 ng/mL), the elevated PMP counts induced by DEX may be responsible for the thrombotic tendency. Conclusion: DEX increases PMP generation via the α₂-adrenoceptor in human platelets.

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