In the fields of emergency medicine and intensive care medicine, acute blood purification therapy has been applied not only as renal replacement therapy, but also for cytokine removal and mediator modulation to improve the outcome in critically ill patients. Continuous blood purification (CBP) therapy is the most frequently performed modality in acute blood purification therapy, and hemofilters are an essential device for CBP. The treatment mode selection and settings of CBP are important to improve the patients’ condition and treatment efficiency. In particular, hemofilter selection is a key in CBP settings. Currently, there are many commercially available hemofilters, and each hemofilter has a unique design to sustain solute removal and anti-coagulation ability for long-term use. Furthermore, differences in the membrane material account for differences in the solute removal, filtration, and cytokine adsorption abilities. In clinical practice, hemofilters must be selected based on the characteristics of each membrane material. In this report, we describe our attempt to classify and evaluate the membrane performances for solute removal, filtration, cytokine adsorption ability and hemofilter life-time based on the membrane material and discuss future perspectives of acute blood purification therapy.

Introduction: Lower gastrointestinal perforation is one of the most common conditions causing sepsis. In this study, we evaluated coagulopathy in the elderly with lower gastrointestinal perforation. Methods: Patients with lower gastrointestinal perforation admitted to our ICU post emergency surgery were enrolled from April 2011 to March 2017. They were classified into the elderly (aged ≥ 75 years) and non-elderly (aged < 75 years) groups. The two groups were compared in terms of coagulation and fibrinolysis markers, DIC score, and SOFA score on days 0, 1, and 2 of ICU admission. Additionally, we evaluated the 28-day survival rate. Results: Overall, 46 patients were included in the study, 23 in the elderly group and 23 in the non-elderly group. DIC scores on days 0 and 1 were significantly higher in the elderly group than in the non-elderly group (both P<0.01), and SOFA score on day 1 was significantly higher in the elderly group than in the non-elderly group (P<0.05). There was no significant difference between two groups in 28-day survival rate [65％ (15/23) vs. 83％ (19/23), P＝0.18; log-rank test, P＝0.17]. Conclusions: Lower gastrointestinal perforation in elderly patients tends to be complicated by coagulopathy.

Objective: This study aimed to analyze the risk factors of delirium after cardiovascular surgery and to formulate and verify a check sheet for assessing the pre-operative risk factors of delirium. Methods: The risk factors for postoperative delirium, including emergency operation, age, length of stay in ICU, and hydroxyzine single use were assessed in 267 patients who underwent cardiovascular surgery. In the ICU, delirium was assessed using the confusion assessment method for the ICU (CAM-ICU) and intensive care delirium screening checklist (ICDSC). In the general ward, the delirium screening tool (DST) was used. A logistic regression analysis was performed to analyze the risk factors of postoperative delirium. Results: The areas under the receiver operating characteristic curves (ROC-AUCs) and the cut-off values of the regression equation for predicting the probability of delirium were 0.822 (0.75-0.90, P<0.001) and 0.114, respectively. Among the two patients who later developed delirium, one was assessed to be at a high-risk for developing delirium based on a positive check sheet. Conclusion: Our results suggested that the preoperative delirium check sheet can help predict the occurrence of delirium after cardiovascular surgery.

Introduction: Coronary artery disease is a well-known cause of cardiac arrest in adults; however, this condition can also cause cardiac arrest in children. In this study, we report cases of out-of-hospital cardiac arrest caused by congenital coronary artery disease. Data were retrospectively obtained from the medical records of patients treated at our hospital for out-of-hospital cardiac arrest （April 2007-March 2017）. Cases: Among the 74 cases of out-of-hospital cardiac arrest that occurred during the 10-year study period, 3 were caused by congenital coronary artery disease. Cases of coronary artery disease included 1 patient each with an anomalous left coronary artery from the pulmonary artery, an anomalous aortic origin of right coronary artery, and an anomalous aortic origin of left coronary artery. Cardiac arrest was triggered in all 3 patients by exercise or crying. One patient with cardiac arrest who was rapidly resuscitated at school survived without sequelae; however, one infant died and the other suffered severe hypoxic encephalopathy. All 3 patients were diagnosed with transthoracic echocardiography. Conclusions: When investigating causes of pediatric cardiogenic cardiac arrest, congenital coronary artery diseases need to be considered.