Purpose: The characteristics of the patients with delayed start of oral intake after acute cardiovascular surgery were surveyed to identify risk factor of delay. Methods: This is a longitudinal observation study. 94 adult patients for whom postoperative rehabilitation was prescribed were classified according to the number of days to starting oral intake into group normal (within 7 days) and group delay (at least 8 days). Characteristics of study patients, intraoperative characteristics, postoperative complications, and postoperative progress were retrospectively surveyed and comparatively analyzed. Furthermore, risk factors that affect delay are extracted by multivariate analysis. Results: Compared with group normal, great vessel diseases were more common in group delay, and ages of the patients were significantly more advanced. And the incidence of complications of cerebrovascular disease, pneumonia, and hoarseness were significantly higher. In addition, duration of mechanical ventilation and sedation, length of ICU stay, postoperative length of hospital stay were longer in group delay, and at the final evaluation, the proportion that Food Intake LEVEL Scale did not reach normal was higher. Furthermore, results of a logistic regression analysis, complications of postoperative cerebrovascular disease (OR: 48.087, 95%CI: 2.517-918.612), postoperative pneumonia (OR: 43.839, 95%CI: 2.244-856.619), and postoperative hoarseness (OR: 8.448, 95%CI: 1.276-55.918) was extracted as significant risk factors of delay. Conclusion: In the case of delayed start of oral intake after surgery, the postoperative progress is poor, and complications of postoperative cerebrovascular disease, pneumonia, and hoarseness are risk factors of delay.

Neurally adjusted ventilatory assist (NAVA) is a mechanical ventilation modality utilizing the electrical activity of the diaphragm (EAdi). EAdi triggers reportedly have significantly shorter delays than other triggers. Patients showing poor synchrony with a ventilator are considered good candidates for NAVA. In a 10-month-old infant with a chronic lung disease, NAVA was useful for improving synchrony with mechanical ventilation. The breathing cycle was very short, as the inspiratory time was 450 msec and the expiratory time was 880 msec as measured by the change in the EAdi. There were a lot of miss-triggering in the flow trigger, as well as a 270 msec trigger delay to the start of inspiration. NAVA improved synchrony with mechanical ventilation by shortening the asynchronous time, which allowed the amount of intravenous sedative to be decreased. The apparent breathing effort of the patient correlated with the EAdi value, which served as a useful index. In the respiratory management of infants with a short respiratory cycle and strong respiratory effort, trigger delay is the main cause of asynchrony. For such patients, NAVA may be useful for improving synchrony with a ventilator.

We herein present a case of quad fever after traumatic spinal cord injury. A 60s man had multiple trauma including head, high spinal cord, thorax and intraperitoneal organ, extremity caused by a traffic accident. ICU day 1, emergent abdominal operation and amputation of lower leg were performed and spinal fusion was operated at ICU day 9. Since ICU day 2, hyperthermia continued even though we administered some broad-spectrum antibiotics. Blood, urine cultures were negative, wound infection wasn’t admitted and thyroid function tests was normal. Diagnosis of the etiology of hyperthermia was challenging, and active extracorporeal cooling by failed to lower temperature. However, the cyclooxygenase (COX)-2 inhibitor naproxen alleviated fever. Quad fever, that is defined hyperthermia after spinal cord injury, is not caused by known infectious or noninfectious agents and is difficult to control, does not respond to most treatment approaches, and may sometimes be fatal. Detailed mechanism underlying quad fever remains unclear. Effective treatment of quad fever has not been established, but COX-2 inhibitors such as naproxen might be effective in controlling quad fever.

There are few reports concerning acute kidney injury after segmental inferior vena cava (IVC) resection. Therefore, we would like to report a case of acute kidney injury due to outflow interruption in the renal vein after segmental IVC resection. Pancreaticoduodenectomy was performed in a 70-year-old woman. Since a tumor had infiltrated the anterior surface of the IVC at the junction of the renal vein, segmental IVC resection was also performed. After the operation, she had decreased urine output despite fluid therapy as well as increased Cr level. Contrast-enhanced CT revealed occlusion of the IVC involving the renal confluence and congestion of the right kidney, which we diagnosed as acute kidney injury due to outflow interruption in the renal vein. We began volume loading and administration of noradrenaline and vasopressin to increase renal perfusion pressure and glomerular filtration rate. Increases in mean blood pressure of 120% and beyond resulted in an increase in urine volume and decrease in Cr level. Subsequent contrast-enhanced CT showed development of collateral circulation and reduction in swelling of the right kidney. Her clinical course afterwards was uneventful. If a decrease in urine volume does not respond to fluid therapy after pancreaticoduodenectomy with segmental IVC resection, the possibility of outflow interruption in the renal vein should be considered.