Evaluation of clinical research priorities in Asian intensive care units (ERA-ICU).

Background: Practice and delivery of critical care in Asia varies according to healthcare structure, income setting, and cultural factors. Identifying research priorities specific to ICU patients and healthcare workers in Asia is needed to guide advancement of critical care in the region.

Methods: This was an international cross-sectional survey study with adapted methods from nominal group techniques.

Impact of the ICU admission of patients with COVID-19 on the outcomes of patients without COVID-19 in the ICU: a retrospective cohort study.

Purpose: This study aimed to elucidate how the admission of patients with coronavirus disease-2019 (COVID-19) to the intensive care unit (ICU) impacts the mortality rate and management of patients without COVID-19 in the ICU, focusing on the condition of patients during and after ICU admission, which has not been sufficiently evaluated.

Methods: This multicenter retrospective cohort study was conducted across 33 ICU facilities in Japan, using data from the Japanese Intensive Care Patient Database for fiscal years 2018-2020. Patients without COVID-19 were admitted to ICUs that also treated patients with COVID-19 during the study period.

Postoperative mortality in patients requiring home oxygen therapy: a nationwide hospital-based database study.

Purpose: To identify the postoperative mortality in patients requiring home oxygen therapy (HOT).

Methods: This descriptive study used a nationwide hospital-based database constructed by JMDC Inc. (Tokyo, Japan).

Prediction of surgery start for automated anesthesia using draping detection from surveillance videos.

One of the primary goals of automated anesthesia is to reduce human intervention and reduce the workload of anesthesiologists. However, switching modes before the start of surgery still requires manual operation. The present study aims to develop a system that predicts the start of surgery by analyzing the actions of medical staff in the operating room using surveillance camera footage, thereby enabling automated mode transitions in anesthesia systems.

STAT1-mediated epigenetic regulation of LIN28A controls iPSC-derived platelet production through the let-7-RALB axis.

Ex vivo platelet (PLT) production from induced pluripotent stem cells (iPSCs) represents a potential solution to address the limitations of donor-dependent PLT transfusion therapy. Although our established immortalized megakaryocyte progenitor cell lines (imMKCLs) from iPSCs enable large-scale production of functional iPSC-derived PLT products, cellular heterogeneity and senescence remain significant challenges for robust industrial-scale manufacturing. We recently identified RAS-like proto-oncogene B as a key regulator of immune properties and PLT productivity of imMKCLs, acting downstream of the let-7a-5p microRNA.

Impact of the Japanese clinical practice guidelines for management of sepsis and septic shock (J-SSCG) 2020 on real-world adherence and interhospital variation: a nationwide inpatient database study.

Background: The Japanese Clinical Practice Guidelines for Management of Sepsis and Septic Shock (J-SSCG) 2020 aimed to standardize sepsis care in Japan. However, the extent of their impact on clinical practice remains uncertain.

Methods: We conducted a nationwide retrospective cohort study using the Japanese Diagnosis Procedure Combination database between April 2018 and December 2021.

Postoperative fluid balance and outcomes in pediatric living-donor liver transplant recipients: a retrospective cohort study.

Purpose: This study aimed to investigate the relationship between postoperative fluid balance (FB) and clinical outcomes in pediatric living-donor liver transplant (LDLT) recipients.

Methods: This retrospective study was conducted at a tertiary care center. Patients aged ≤ 18 years who underwent LDLT between January 2010 and September 2023 were included.

Comprehensive evaluation of coagulability using thromboelastography in four patients with essential thrombocythemia.

Background: Essential thrombocythemia (ET) is a myeloproliferative neoplasm characterized by increased platelet count and risk of thrombosis and bleeding, which necessitates careful perioperative management. However, there are no standardized guidelines for perioperative antithrombotic therapy, and optimal preoperative evaluation remains unclear. In this report, we evaluate the utility of thromboelastography (TEG®6 s) for assessing coagulation and platelet function in ET patients undergoing surgery.

Anesthetic management of coronary artery reconstruction in a patient with myocardial ischemia caused by an anomalous origin of the right coronary artery running between the great vessels: a case report.

Background: Coronary artery origin anomalies, though often incidentally detected, can lead to sudden death. Comprehensive perioperative management is essential. We report a case of an anomalous right coronary artery (RCA) arising from the left main coronary artery (LMCA) and coursing between the aorta and pulmonary artery, discovered after myocardial infarction, in which intraoperative management ensured successful coronary reconstruction.

Postoperative organ dysfunction assessed using simplified eSOFA is associated with mortality: a single-center retrospective cohort study.

Purpose: This study aimed to determine the association between postoperative organ dysfunction evaluated using eSOFA, a simplified measure of organ dysfunction, and postoperative mortality following noncardiac surgery.

Methods: This study retrospectively analyzed adult patients who underwent noncardiac surgery under general anesthesia between 2009 and 2019. The primary exposure was postoperative organ dysfunction evaluated using eSOFA within 2 postoperative days (positive eSOFA), and the primary outcome was 90-day mortality.

Clinical predictors of extubation failure in postoperative critically ill patients: a post-hoc analysis of a multicenter prospective observational study.

Background: Postoperative patients constitute majority of critically ill patients, although factors predicting extubation failure in this group of patients remain unidentified. Aiming to propose clinical predictors of reintubation in postoperative patients, we conducted a post-hoc analysis of a multicenter prospective observational study.

Methods: This study included postoperative critically ill patients who underwent mechanical ventilation for > 24 h and were extubated after a successful 30-min spontaneous breathing trial.

The Japanese Clinical Practice Guidelines for Management of Sepsis and Septic Shock 2024.

The 2024 revised edition of the Japanese Clinical Practice Guidelines for Management of Sepsis and Septic Shock (J-SSCG 2024) is published by the Japanese Society of Intensive Care Medicine and the Japanese Association for Acute Medicine. This is the fourth revision since the first edition was published in 2012. The purpose of the guidelines is to assist healthcare providers in making appropriate decisions in the treatment of sepsis and septic shock, leading to improved patient outcomes.

Volatile Anesthetic-Induced Skeletal Muscle Atrophy in Mice and Murine-Derived Myotubes: The Role of the Akt Pathway.

Background: Volatile anesthetics are gaining attention as sedatives in intensive care units. Sedation is a significant risk factor for skeletal muscle atrophy and weakness in critically ill patients; however, volatile anesthetics' influence on skeletal muscle atrophy remains unclear. Therefore, we investigated their effects on skeletal muscle mass using a murine-derived muscle cell line and mice.

The Japanese Clinical Practice Guidelines for Management of Sepsis and Septic Shock 2024.

The 2024 revised edition of the Japanese Clinical Practice Guidelines for Management of Sepsis and Septic Shock (J-SSCG 2024) is published by the Japanese Society of Intensive Care Medicine and the Japanese Association for Acute Medicine. This is the fourth revision since the first edition was published in 2012. The purpose of the guidelines is to assist healthcare providers in making appropriate decisions in the treatment of sepsis and septic shock, leading to improved patient outcomes.

Preoperative forced expiratory volume in one second and postoperative respiratory outcomes in nonpulmonary and noncardiac surgery: a retrospective cohort study.

Background: Although the usefulness of pulmonary function tests has been established for lung resection and coronary artery bypass surgeries, the association between preoperative pulmonary function test and postoperative respiratory complications in nonpulmonary and noncardiac surgery is inconclusive. The purpose of this study was to determine the association between preoperative forced expiratory volume in one second (FEV1) on pulmonary function test and the development of postoperative respiratory failure and/or death in patients undergoing major nonpulmonary and noncardiac surgery.

Methods: Adult patients aged ≥ 18 years and who underwent nonpulmonary and noncardiac surgery with expected moderate to high risk of perioperative complications from June 2012 to March 2019 were included.

Uneventful vaginal delivery using epidural anesthesia in patient with exercise induced anaphylaxis: a case report and literature review.

Exercise induced anaphylaxis (EIA) is a rare and potentially life-threatening syndrome characterized by anaphylaxis provoked by exercise. Although vaginal delivery with labor pain is a physical strain for women and a possible trigger for EIA, no consensus exists on the management strategy of delivery in patients with EIA. A 28-year-old primigravida was referred to our hospital because of history of EIA, associated with pruritus, urticaria, and respiratory distress, exacerbated during physical activity.

Benefits and Harms of Procalcitonin- or C-Reactive Protein-Guided Antimicrobial Discontinuation in Critically Ill Adults With Sepsis: A Systematic Review and Network Meta-Analysis.

Objectives: In sepsis treatment, antibiotics are crucial, but overuse risks development of antibiotic resistance. Recent guidelines recommended the use of procalcitonin to guide antibiotic cessation, but solid evidence is insufficient. Recently, concerns were raised that this strategy would increase recurrence.

The optimal glycemic target in critically ill patients: an updated network meta-analysis.

Acute glycemic control significantly affects the clinical outcomes of critically ill patients. This updated network meta-analysis examines the benefits and harms of four target blood glucose levels (< 110, 110-144, 144-180, and > 180 mg/dL). Analyzing data of 27,541 patients from 37 trials, the surface under the cumulative ranking curve for mortality and hypoglycemia was highest at a target blood glucose level of 144-180 mg/dL, while for infection and acute kidney injury at 110-144 mg/dL.

Remimazolam in perioperative management of Eisenmenger syndrome: a case report.

Background: Eisenmenger syndrome (ES) is characterized by severe and irreversible pulmonary hypertension stemming from an uncorrected intracardiac shunt of significant size. The imbalance between systemic and pulmonary artery pressures predisposes patients with ES to the risk of cardiac arrest. Remimazolam has caused less circulatory depression, which may be advantageous for ES.

Prognostic evaluation of quick sequential organ failure assessment score in ICU patients with sepsis across different income settings.

Background: There is conflicting evidence on association between quick sequential organ failure assessment (qSOFA) and sepsis mortality in ICU patients. The primary aim of this study was to determine the association between qSOFA and 28-day mortality in ICU patients admitted for sepsis. Association of qSOFA with early (3-day), medium (28-day), late (90-day) mortality was assessed in low and lower middle income (LLMIC), upper middle income (UMIC) and high income (HIC) countries/regions.