Two types of cardiac ultrasound examinations are adopted in the field of intensive care: focused cardiac ultrasound (FoCUS), which is performed for a limited number of critical cardiac conditions, as a point-of-care ultrasound, and comprehensive echocardiography, which is performed using a comprehensive protocol and is aimed at diagnosing a wide spectrum of cardiac conditions. As FoCUS is often performed by general intensivists and not necessarily cardiologists, it is important to know not only the purpose and protocol of FoCUS, but also the limitations of FoCUS and the specific conditions for which comprehensive echocardiography is indicated for avoiding misdiagnosis by FoCUS. This review provides an overview of and the limitations of FoCUS and a comparison between FoCUS and comprehensive echocardiography.

The recent unexpected emergence of several respiratory viral infections poses a significant public health threat. These infections are associated with serious health conditions that are not only therapeutically challenging but also lead to the depletion of medical resources. Kampo medicine interprets the conditions of infections using the original method regardless of the pathogen. Progression of the infection is classified into six stages based on the disease course and host condition. Kampo medicine was used during previous viral pandemics to treat inflammation and prevent rapid deterioration of the disease. The mechanisms underlying the therapeutic actions of kampo medicine are complicated because these formulations contain multiple components. Basic research has proved that kampo preparations show antiviral and antiproliferative effects, cytokine-modulating action, and protective effects against organ dysfunction. The concept of regulating host homeostasis is an approach based on the characteristics of kampo medicine and may be a treatment option in intensive care.

Objectives: This study aimed to identify factors associated with medication non-adherence at hospital discharge and calculate cut-off values for these factors. Methods: A logistic regression model was prepared using a retrospective dataset of 141 cases. Age, sex, the number of drugs prescribed after ICU discharge, the score on the motor and cognitive components of the functional independence measure (FIM), and the Charlson comorbidity index score were analyzed as potential independent risk factors for medication non-adherence after discharge. Cut-off values and diagnostic accuracy were evaluated by receiver operating characteristic curve, and the results were calibrated against another retrospective dataset of 72 cases, which was collected over a different period. Results: The age ≥75 years (OR 3.81, 95%CI 1.33–10.9) and scoring ≤4 on more than one item in the cognitive component of the FIM were found to be independent risk factors for medication non-adherence after ICU discharge. A FIM cognitive score cut-off of ≤26 had high diagnostic accuracy (sensitivity 62.5%, specificity 88.1%), and the accuracy ratio was highly consistent between the two datasets. Conclusions: The FIM cognitive score and age at ICU admission were independent risk factors for medication non-adherence after discharge, and the diagnostic accuracy was highest for a FIM cognitive score cut-off of 26 points or less.

Temporal lobe epilepsy is sometimes associated with bradycardia and asystole, which is known as ictal bradycardia (IB) syndrome. Herein, we report a case of a patient with an intractable temporal lobe epilepsy with antibodies directed against glutamic acid decarboxylase (anti-GAD-Abs), who repeatedly experienced sudden bradycardic attacks (BAs). A 30-year-old woman with a history of left temporal lobe epilepsy and extremely high anti-GAD-Abs titers developed high fever and dyspnea. She was admitted under a diagnosis of septic pyelonephritis and subsequent acute kidney injury. During treatment, she experienced three episodes of BAs without any warning signs. All of the BAs were treatment resistant, and the second attack even occurred in clusters. Despite intensive care treatment, including a catecholamine injection, a third BA recurred, causing her death. A review of her electrolyte levels throughout the three BAs revealed that she had moderate hypophosphatemia during the second and third attack, which possibly lessened the threshold level of epilepsy. The patient’s epilepsy was intrinsically difficult to control, therefore we assumed that the BAs were recurring due to IB. When IB is suspected in an intractable epilepsy patient, electroencephalogram monitoring allows us to make a diagnosis of IB syndrome. Additionally, external pacing therapy should be considered until epilepsy is controlled.

Malignant catatonia is a syndrome characterized by psychomotor disorder with autonomic symptoms and hyperthermia. A 53-year-old woman with schizophrenia presented hyperthermia, immobility, mutism and rigidity, and was transported to our emergency room. After admission to the psychiatric ward, she developed respiratory failure. She was brought to the ICU and intensive care was initiated. After the exclusion of neuroleptic malignant syndrome and other physical diseases, we suspected malignant catatonia due to an exacerbation of schizophrenia. Thus, we administered lorazepam (1 mg, intravenously). Three minutes after the administration of lorazepam, her immobility, mutism and rigidity were ameliorated. When malignant catatonia is suspected, malignant catatonia should be differentially diagnosed from other physical diseases, while general care is provided to prevent complications. Then, a therapeutic diagnosis with lorazepam should be considered. Because lorazepam has a rapid onset, it is appropriate for the diagnosis and treatment of malignant catatonia.

Acute caffeine intoxication by an overdose shows a dose-dependent response and its symptoms and mechanism are similar to those of acute intoxication caused by theophylline, which is also a xanthine derivative. We experienced a case of acute caffeine intoxication with a lethal dose and performed hemodialysis (HD) to improve the addiction. We examined a therapeutic strategy based on changes in blood levels of caffeine and theophylline, which is an intermediate metabolite, during the course of HD. The blood levels of caffeine and theophylline showed different trends in the early period of internal use. After HD, the blood levels of caffeine and theophylline showed similar trends including the time when the blood levels of caffeine rose again due to intestinal reabsorption. Theophylline may be a useful indicator of re-increase in blood concentration due to a drug overdose.