Shor-term mortality of critically ill patients has improved dramatically with recent advances in intensive care modalities. In contrast, long-term decline of the quality of life after intensive care is common, and is an emerging challenge for better quality of intensive care. Chronic pain is one of the common medical problems in the population and is associated with deterioration in the quality of life. In regard to the mechanism of pain, the origin of the pain has been conceptualized into three pain phenotypes: Nociceptive, Neuropathic, and Nociplastic pain. Epidemiological studies have suggested that approximately a half of the patients experience chronic pain, and in 50% of these patients, the pain is associated with a history of intensive care (chronic post intensive-care pain, CPIP). Moderate to severe pain is common in patients with CPIP and is frequently associated with disturbance of the activities of daily living. Treatment of chronic pain must be planned depending on which of the three mechanisms is thought to be operative; CPIP should be treated in accordance with this principle as well. To develop the prevention strategy, factors that lead to the development of CPIP need to be determined. Several risk factors associated with post intensive care symptoms (PICS) may also development of CPIP. Therefore, preventive strategies against CPIP must be developed along the lines of those for PICS prevention.

Refractory advanced heart failure is a challenging condition to treat, with a poor prognosis. Recently, the treatment of advanced heart failure has dramatically changed with progress in the field of heart transplantation and use of ventricular assist devices (VADs). In particular, the performance and outcome of VADs has improved, contributing to improved prognosis. In Japan, the National Health Insurance began to cover implantable VADs from May 2021 for patients who are not eligible for heart transplantation (destination therapy, DT). Therefore, the number of patients requiring DT is expanding, and it is necessary for intensivists to understand the treatment options so as to decide whether to switch to VAD therapy or not during the management of patients with advanced heart failure. In addition, it is important to consider consultation and transfer to a heart transplant or DT facility without missing the right timing. Furthermore, as the number of VAD patients is expected to increase in the future, it is necessary to learn the mechanism of functioning and emergency care of VADs.

Objectives: This study investigates factors associated with the development of psychiatric symptoms after hospital discharge in family members of patients admitted to the ICU. Methods: This study is a case-control study conducted after the main analysis. This study explored the medical history of patients who were admitted to the ICU for 48 hours or more, and those of family members who had visited the ICU at least once. Patients and family members were divided into two groups:those with and those without psychiatric symptoms [Hospital Anxiety and Depression Scale (HADS) anxiety≧8 or HADS depression≧8 or impact of event scale-revised (IES-R)≧25]. Factors associated with psychiatric symptoms were retrospectively examined. Results: Among the family members of 178 discharged patients who survived, 61 were included in the analysis who were available for participation in the study three months after discharge from the hospital. There were 20 (33%) family members with psychiatric symptoms. The psychiatric symptoms experienced by the patients’ family members were associated with the patients’ Barthel index (P=0.013) and HADS depression (P=0.010) at the time of hospital discharge. However, multivariate analysis revealed no significant associated factors. Conclusion: The patient’s decreased independence in activities of daily living and psychiatric symptoms at the time of discharge may be related to the occurrence of psychiatric symptoms in family members 3 months after discharge.

A 70-year-old man was diagnosed with chronic lymphocytic leukemia at the age of 69 and was under observation. Ibrutinib was initiated due to stage progression. However, ibrutinib administration was discontinued after 1 month due to liver dysfunction. The peripheral hematological picture suggested diffuse large B-cell lymphoma. Four days after ibrutinib discontinuation, lactic acidosis with hypoglycemia was observed, and the patient was admitted to the ICU. Ventilatory management, blood glucose correction, fursultiamine administration, and blood purification therapy did not improve the patient's condition, and the Warburg effect on type B lactic acidosis was thought to be the cause. It was decided that intervention for the primary disease was necessary, and miniCHOP therapy (cyclophosphamide, doxorubicin hydrochloride, vincristine, prednisolone) was started on the same day. On the next day, the lactate level improved and the number of tumor cells in the peripheral blood decreased. Although initiation of chemotherapy is often hesitated for patients with malignant tumors associated with lactic acidosis because of their poor general conditions, the possibility that earlier initiation may be effective should be considered.