Purpose: In order to identify factors related to independence of walking at discharge in patients on mechanical ventilators (MV) for more than 48 hours. Methods: This retrospective study was conducted in 81 of survivors on MV for more than 48 hours in ICU stay at our hospital from June 2016 to October 2017. Clinical data were statistically analyzed to detect factors related to the walking ability at discharge in such patients. The data were collected from medical records at ICU discharge. Results: There were significant differences in age, functional comorbidity index (FCI), delirium at ICU discharge and the functional status score for the ICU (FSS-ICU) at ICU discharge between the groups with and without walking independence. A multivariate logistic regression analysis showed that independent factors associated with independence of walking were the FSS-ICU at ICU discharge (OR: 1.21, 95%CI: 1.09-1.34, P<0.01) and FCI (OR: 0.62, 95%CI: 0.40-0.95, P=0.02). Conclusions: In survivors with prolonged MV, the independence of basic activities and FCI at ICU discharge contributed more to the independence of walking than the severity of illness in ICU.

Background: The rise in hospital costs caused by increased length of hospital stay (LOS) is a problem in Japan. A previous study showed increased LOS in critically ill patients in the ICU. Therefore, predicting discharge of critically ill patients and proper preparation for patient transfer may reduce LOS. The functional status score for the ICU (FSS-ICU) is a physical function measure specifically designed for the ICU whose factors are significantly predictive of patient discharge. However, cutoff values for the FSS-ICU are unclear. This study aimed to determine a cutoff value for FSS-ICU to predict patient discharge of critically ill ICU patients. Methods: This retrospective study enrolled adult critically ill patients admitted from home who had been on mechanical ventilation for >48 hours. Multivariable logistic regression analysis was performed to confirm the relevance of the FSS-ICU to patient discharge. A receiver operating characteristic (ROC) curve for the FSS-ICU for patient discharge was calculated to determine the cutoff value by Youden index. Results: This analysis included 200 patients (age: 72.0 [58.0-80.0] years; male: 60.0%; APACHE II score: 24.6±7.9). Median FSS-ICU was 12.5 [0.0-22.0] points, and 61 (30.5%) patients were discharged home. Multivariable logistic regression analysis showed the FSS-ICU at ICU discharge to be a significant factor predictive of patient discharge (OR: 1.200, 95%CI: 1.120-1.290, P<0.001). The ROC area under the curve for the FSS-ICU for patient discharge was 0.864 (95%CI 0.810-0.917). The cutoff value for the FSS-ICU was 16 points (sensitivity 0.820, specificity 0.764). Conclusions: The cutoff value of the FSS-ICU to predict discharge home in critically ill ICU patients was 16 points. Therefore, patients with an FSS-ICU below this cutoff value may require proper preparation for patient transfer to decrease their LOS.

We report herein a case of 47-day-old male patient with critical pertussis and pulmonary hypertension treated by long-term extracorporeal membrane oxygenation (ECMO). After the onset of severe respiratory distress caused by pertussis, leukodepletion was performed on the day 10 of illness before obvious pulmonary hypertension developed. However, on day 12 of illness, his pulmonary hypertension became obvious and compromised his systemic circulation. Veno arterial-ECMO (VA-ECMO) was therefore begun on day 12 of illness. The ECMO configuration mode was switched from VA to veno-veno arterial (V-VA) on day 32 of illness to assess the safety of weaning, and balloon atrial septostomy (BAS) was done on day 35 of illness to maintain systemic blood flow. The patient received aggressive physiotherapy and repetitive bronchoscopic suctioning thereafter. He was weaned from ECMO support on the day 45 of illness, 34 days after the initiation of ECMO. He was discharged from the hospital without neurocognitive or respiratory sequelae on day 124. His cardiac catheterization after one year revealed no pulmonary hypertension. Long-term ECMO with careful assessment and aggressive management, including V-VA ECMO and BAS, is a potential therapeutic option for critical pertussis in infants with the complication of severe pulmonary hypertension.

We carried out medical jet transport of a patient with cardiac failure using an IMPELLA^® device to provide temporary circulation pump support. A-12-year-old girl was transferred to our hospital due to acute cardiac failure by the helicopter from a regional hospital 300 km away. Despite intensive care for dilated cardiomyopathy, she developed cardiogenic shock and required an IMPELLA^® device one month after admission. To facilitate transport to the pediatric heart transplant center, 1,000 km away, we decided to use medical jet. To minimize the risk of catheter displacement, a special spineboard with all necessary equipment and a portable ultrasound machine were prepared, and simulation exercises for each situation were performed in advance, so she was safely transported without any complications. The regular commitment of all members including nonmedical staff contributed to the smooth transport of this patient via medical jet system.

We have reported a case of massive cervical lymphangioma, which was diagnosed prenatally, and the baby was born under a elective caesarean section without any complications. However 10 days after birth, the neonate experienced exacerbated airway stenosis due to the natural and the treatment-related enlargement of the tumor. Then, emergency intubation was needed, but was difficult to perform. Finally, it was achieved using a fiber-optic scope and a video laryngoscopy. It should be noted that careful airway managements for fetal cervical tumors may be needed not only just after the birth but also for any time especially following the treatment for the tumor, because it may make the airway stenosis worse. Multidisciplinary team approach with neonatologists, pediatric surgeons, anesthesiologists, intensivists and so on are needed to save such kind of patients.