Nutritional support has undergone many changes over time, and international guidelines now recommend that enteral nutrition replace parenteral nutrition in critically ill patients. Several studies have supported its effectiveness in maintaining bowel structure and function, and preventing infections involving processes like bacterial translocation. Guidelines recommend that enteral nutrition is started at least within 24-48 hours; however, in clinical studies, early enteral nutrition has not shown superiority compared to late (delayed) enteral nutrition and parenteral nutrition. Nutritional therapy remains controversial, not only in terms of initiation timing but also concerning its role in different diseases, the quantity of enteral nutrition, and evaluation methods. This review aimed to help clinicians develop an understanding of the effectiveness, limitations, and future directions of early enteral nutrition, and to reconsider the notion that “earlier is better”.

High temperature shortens cardiac contraction time and relaxation time, and low temperature extends them. Goodness of half-logistic (h-L) function fits are superior to goodness of mono-exponential (m-E) function fits for the four phases; the first half of the ascending phase, second half of the ascending phase, first half of the descending phase, and second half of the descending phase of the isovolumic left ventricular pressure-time curve in the excised, cross-circulated canine heart at any temperatures. Four h-L time constants obtained by the h-L curve fittings extend with decreasing temperature and shorten with increasing temperature. Moreover, goodness of h-L function fits are superior to goodness of m-E function fits for the four phases of the isometric force-time curve and intracellular free calcium transient-time curve observed in the rat right ventricular papillary muscle and mouse left ventricular papillary muscle at low temperature. Four h-L time constants can be indices to evaluate cardiac or myocardial inotropic and lusitropic functions, and contraction process and relaxation process of intracellular free calcium transient accurately regardless of change in temperature.

Objective: To assess the utility of the functional status score for the ICU (FSS-ICU) for predicting discharge outcome in patients who experience successful resuscitation after cardiopulmonary arrest on arrival (CPAOA). Methods: We retrospectively identified 15 CPAOA patients who required physical therapy in the ICU or high care unit (HCU) from April 2015 to February 2018. We compared data from before admission, during admission, and at discharge from the ICU/HCU between home and transfer groups. We also calculated the area under the curve (AUC) of five models [cerebral performance category (CPC), FSS-ICU, decision-tree model before admission, decision-tree model + CPC, and decision-tree model + FSS-ICU)], and compared the accuracy in predicting prognosis. Results: The home group consisted of nine patients and had significantly higher FSS-ICU scores for rolling, supine-to-sit movements, and sitting than the transfer group. The decision-tree model + FSS-ICU had the highest accuracy among the five models. Conclusions: CPAOA patients showed significant differences in FSS-ICU at discharge from ICU/HCU. We believe that the decision-tree model + FSS-ICU was the most accurate in terms of predicting prognosis.

Lidocaine/propitocaine cream (EMLA^® cream) is used in skin laser irradiation therapy and for pain relief arising during injection and from indwelling venous cannulae. We report the case of a 1-month-old girl who experienced methemoglobinemia after administration of this drug and required intensive care management. The symptoms improved with administration of methylthioninium, and she was discharged without neurological sequelae. To our knowledge, there are no previous reports of methemoglobinemia caused by the application of this drug in Japan. As our patient was a young infant, the cytochrome-b₅ reductase activity that reduces methemoglobin was lower than that of adults, and there are easily oxidizable fetal hemoglobin. It was thought that lidocaine and propitocaine, and their metabolism caused methemoglobinemia against this background. Attention is required in the use of lidocaine/propitocaine cream for neonates and young infants, and it should be used according to age-adapted dose and application time. With the occurrence of central cyanosis that does not improve even with oxygen administration, or when there is a discrepancy between SaO₂ and SpO₂, it is necessary to consider methemoglobinemia.

A web questionnaire survey on work-life balance was carried out in all members of the Japanese Society of Intensive Care Medicine for the session on the work-life balance in the 45th annual meeting of the Japanese Society of Intensive Care. The survey indicated that the ideal work-life balance was not attained; work-life balance is an unsolved issue for the society’s members. Further efforts will be required to present attractive ways of working for the members who bear the future of critical care medicine.