Both immunocompromised patients and immunocompetent critically ill patients have high risks of developing cytomegalovirus (CMV) infection. In critically ill patients, CMV infection is associated with prolonged duration of mechanical ventilation and ICU/hospital stay, and increased mortality. CMV infection in immunocompetent critically ill patients has become a hot topic; randomized clinical trials have been conducted to investigate the efficacy of antiviral therapy for preventing CMV infection in these patients. To date, antiviral prophylaxis therapy has been shown to suppress CMV reactivation, but without positive effects on clinical outcomes such as mortality rates. Anti-CMV drugs are also known for the frequent occurrence of severe side effects. Therefore, antiviral therapy has not been recommended for preventing CMV infection in immunocompetent critically ill patients. Anti-CMV drugs with reduced risks of myelosuppressive effects or renal toxicity are currently under clinical trials. It is essential to keep updated knowledge on the emerging findings regarding CMV infection in critically ill patients.

Objective: We aimed to identify predictive factors of delayed mobilization in ventilated blunt trauma patients. Methods: We retrospectively reviewed 257 consecutive blunt trauma patients who required mechanical ventilation for at least 24 hours between April 2013 and December 2016. The study outcome was the achievement of an upright sitting position out of bed. First, we performed the cumulative incidence function (CIF) approach and the Gray’s test. Second, the Fine-Gray competing risk regression model was applied to investigate the impact of injury location on mobilization. Results: Male sex (P=0.029), injury severity score (ISS) ≥ 25 (P<0.001) and revised trauma score (RTS) <6 (P<0.001) was significantly associated with delayed mobilization. In the Fine-Gray competing risk regression model, spine injury (adjusted hazard ratio 0.64, 95%CI 0.44-0.94, P=0.022) and pelvis/extremity injury (adjusted hazard ratio 0.71, 95%CI 0.53-0.95, P=0.020) were independent predictive factors of delayed mobilization, even after adjustment for sex, ISS and RTS. Conclusion: Sex, high ISS and low RTS, spine injury, and pelvis/extremity injury independently predicted delayed mobilization in ventilated blunt trauma patients.

Patient: Thirty-three-year-old female. Medical past history: systemic lupus erythematosus, central hypothyroidism. After emergency transport to the previous doctor due to a disturbance of consciousness (GCS E1V1M1), the patient was intubated and transferred to our hospital. Upon arrival, the patient exhibited systemic tonic convulsions, determined to be status epilepticus (SE), that did not cease upon administration of midazolam and propofol. We attempted to secure a central venous route for further administration of thiopental, but this was difficult owing to the convulsions. We attempted to control the seizures by using inhalational anesthetics. The seizures temporarily ceased after approximately 10 minutes of desflurane administration. A central venous route was secured and we initiated thiopental administration. After a total of two hours of desflurane administration, convulsion cessation was confirmed. Subsequently, intravenous anesthetic administration was tapered and discontinued, and oral anticonvulsant treatment was initiated. Electroencephalography on the 4th hospital day revealed a burst-suppression pattern. We consider the concomitant use of inhalational anesthetics to be useful as a treatment for intractable SE.

We retrospectively analyzed data from the International Nutrition Surveys of 2011 and 2013, and evaluated the relationship between the adequacy of energy intake and mortality in critically ill patients in Japan. We included 169 enterally-fed patients in ICU for more than 7 days. There was a significant difference in adequacy of median caloric intake between patients who survived and those who died (51.3% vs. 41.0%, P<0.01). Lower in-hospital mortality within 60 days was observed with greater caloric intake during the first 12 days in the ICU (every 10%-increase in caloric adequacy) (OR 0.74, 95%CI 0.61-0.89, P<0.01), and the surgical patients (OR 0.23, 95%CI 0.09-0.62, P<0.01). However, neither the Acute Physiology and Chronic Health Evaluation II score nor the body mass index was associated with mortality. In conclusion, greater caloric intake was associated with lower in-hospital mortality within 60 days in Japan.

Purpose: Flow-inflating resuscitation bags are useful to maintain a PEEP and to adjust the ventilation pressure in seriously ill patients. Although manometers are commonly used to prevent lung damage, their practical use in the pediatric intensive care unit is limited. The purpose of this study is to verify the accuracy of blind ventilation and manometer ventilation. Methods: Thirty-six nurses and doctors (29 nurses: years of experience, 7.2±5.1; years of PICU experience, 3.0±3.7; 7 doctors: years of experience, 10.3±1.9; years of PICU experience, 4.0±2.4) participated in this study. Blind ventilation and manometer ventilation were conducted using model lungs under various ventilation conditions. The obtained data analyzed using SPSS ver.22. Results: Using manometer allowed lower peak inspiratory pressure (PIP) than blind manual ventilation in the injured lung model. Hence, PEEP levels were maintained higher by manometer use. Conclusion: Using manometer may prevent excessively high PIP than blind manual ventilation in the lung injury.