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Enomoto Y, Tsuchiya A, Tsutsumi Y, Ishigami K, Osone J, Togo M, Yasuda S, Inoue Y. Association between physician-staffed helicopter versus ground emergency medical services and mortality for pediatric trauma patients: A retrospective nationwide cohort study. PLoS One 2020; 15:e0237192. [PMID: 32785294 PMCID: PMC7423096 DOI: 10.1371/journal.pone.0237192] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2020] [Accepted: 07/21/2020] [Indexed: 11/18/2022] Open
Abstract
Background Helicopter emergency medical services’ (HEMS) effectiveness for pediatric trauma patients remains unclear. We aimed to examine the relation between HEMS and reduced mortality in pediatric trauma patients. Methods This retrospective cohort study utilized data from the Japan Trauma Data Bank, a national multicenter clinical trauma database. Participants were aged <18 years, admitted between 2004 and 2015, and transported from the scene to the hospital by HEMS or ground emergency medical services (GEMS). We used a standardized mortality ratio (SMR) weight method, and fitted a marginal structural model to adjust for measured confounders. The SMR weight was calculated using the estimation of the propensity scores. A logistic regression model was used with the baseline independent variables to estimate the propensity score. Results Overall, 5,947 patients were identified in our study: 453 were transported by HEMS and 5,494 by GEMS. The mean injury severity score in the HEMS group was significantly higher than that in the GEMS group17.0 (Standard deviation = 11.0) vs 12.2 (Standard deviation = 9.2), p < .001. In-hospital mortality was higher in the HEMS group than that in the GEMS group in the unadjusted analysis (3.8% vs 1.3%, respectively; p < .001). After adjusting for covariates, HEMS transport was not associated with reduced hospital mortality. (odds ratio = 0.82, 95% confidence interval = 0.42–1.58). Conclusions HEMS was not associated with reduced mortality among pediatric trauma patients compared with GEMS in this nationwide study. Further investigation is necessary to determine who clearly benefits from HEMS as compared to GEMS.
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Affiliation(s)
- Yuki Enomoto
- Department of Emergency and Critical Care Medicine, Faculty of Medicine, University of Tsukuba, Ibaraki, Japan
- Department of Emergency and Critical Care Medicine, National Hospital Organization Mito Medical Center, Ibaraki, Japan
- * E-mail:
| | - Asuka Tsuchiya
- Department of Emergency and Critical Care Medicine, National Hospital Organization Mito Medical Center, Ibaraki, Japan
- Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, Tokyo, Japan
| | - Yusuke Tsutsumi
- Department of Emergency and Critical Care Medicine, National Hospital Organization Mito Medical Center, Ibaraki, Japan
| | - Koji Ishigami
- Department of Emergency and Critical Care Medicine, National Hospital Organization Mito Medical Center, Ibaraki, Japan
| | - Junpei Osone
- Department of Emergency and Critical Care Medicine, National Hospital Organization Mito Medical Center, Ibaraki, Japan
| | - Masahito Togo
- Department of Emergency and Critical Care Medicine, National Hospital Organization Mito Medical Center, Ibaraki, Japan
| | - Susumu Yasuda
- Department of Emergency and Critical Care Medicine, National Hospital Organization Mito Medical Center, Ibaraki, Japan
| | - Yoshiaki Inoue
- Department of Emergency and Critical Care Medicine, Faculty of Medicine, University of Tsukuba, Ibaraki, Japan
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Yamada C, Iwawaki Y, Harada K, Fukui M, Morimoto M, Yamanaka R. Frequency and risk factors for subsyndromal delirium in an intensive care unit. Intensive Crit Care Nurs 2018; 47:15-22. [PMID: 29606481 DOI: 10.1016/j.iccn.2018.02.010] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2017] [Revised: 02/20/2018] [Accepted: 02/26/2018] [Indexed: 01/05/2023]
Abstract
OBJECTIVE Delirium and subsyndromal delirium in critically ill patients are important determinants of long-term functional disability and cognitive impairment. However, few outcome studies on sub-syndromal delirium have been reported. Thus, this study aimed to evaluate the incidence of delirium and sub-syndromal delirium as well as the risk factors and progression to delirium. DESIGN A prospective cohort study. SETTING Six bed medical and surgical intensive care unit in Otsu Municipal Hospital in Japan. METHODS Delirium and sub syndromal delirium were evaluated using the Intensive Care Delirium Screening Checklist scores and the demographic data of the patients recorded. Statistical analyses were conducted using the Mann-Whitney U test and chi-square test for comparison. We also compared groups using multivariate analyses. RESULTS Of the 380 patients who were screened, 15.8% and 33.9% had delirium or sub syndromal delirium, respectively and 9.5% of patients progressed from a state of sub syndromal delirium to delirium. Older age, predisposing cognitive impairment, blood transfusion, higher Acute Physiology and Chronic Health Evaluation II (APACHE II) score, low red blood cell count and high C-reactive protein levels were the risk factors highly associated with subsyndromal delirium symptoms. Older age, acute admission, steroid use, the utilisation of restraints and lower PaO2 were the determinants of progression to delirium. CONCLUSIONS A high incidence of sub syndromal delirium was observed in critically ill patients. Patient with sub syndromal delirium must be promptly identified and treated due to the risk of progression to delirium.
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Affiliation(s)
- Chikayo Yamada
- Graduate School of Nursing for Health Care Science, Kyoto Prefectural University of Medicine, Kyoto, Japan; Department of Emergency and Intensive Care Medicine, Otsu Municipal Hospital, Otsu, Shiga, Japan.
| | - Yoko Iwawaki
- Graduate School of Nursing for Health Care Science, Kyoto Prefectural University of Medicine, Kyoto, Japan.
| | - Kiyomi Harada
- Graduate School of Nursing for Health Care Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Michihiko Fukui
- Department of Emergency and Intensive Care Medicine, Otsu Municipal Hospital, Otsu, Shiga, Japan
| | - Masafumi Morimoto
- Graduate School of Nursing for Health Care Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Ryuya Yamanaka
- Graduate School of Nursing for Health Care Science, Kyoto Prefectural University of Medicine, Kyoto, Japan; Laboratory of Molecular Target Therapy for Cancer, Graduate School for Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan.
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Nishimura M, Kobayashi S, Kinjo Y, Hokama Y, Sugawara K, Tsuchida Y, Tominaga D, Ishiuchi S. Factors Leading to Improved Gait Function in Patients with Subacute or Chronic Central Nervous System Impairments Who Receive Functional Training with the Robot Suit Hybrid Assistive Limb. Neurol Med Chir (Tokyo) 2017; 58:39-48. [PMID: 29199246 PMCID: PMC5785696 DOI: 10.2176/nmc.oa.2017-0082] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023] Open
Abstract
The factors that lead to the improvement of gait function in patients with diseases of the central nervous system (CNS) who use a hybrid assistive limb (HAL) are not yet fully understood. The purpose of the present study was to analyze these factors to determine the prognosis of the patients' gait function. Patients whose CNS disease was within 180 days since onset were designated as the subacute-phase patients, and patients whose disease onset had occurred more than 180 days previously were designated as chronic-phase patients. Fifteen subacute-phase patients and 15 chronic-phase patients were given HAL training. The study analyzed how post-training walking independence in these patients was affected by the following factors: age, disease, lesion area, lower limb function, balance, period until the start of training, number of training sessions, additional rehabilitation, higher-order cognitive dysfunction, HAL model, and the use of a non-weight-bearing walking-aid. In subacute-phase patients, walking independence was related to lower limb function (rs = 0.35). In chronic-phase patients, there was a statistically significant correlation between post-training walking independence and balance (rs = 0.78). In addition, in patients with a severe motor dysfunction that was accompanied by inattention and global cognitive dysfunction, little improvement occurred, even with double-leg model training, because they had difficulty wearing the device. The results demonstrated that the factors that improved walking independence post HAL training differed between patients with subacute- and chronic-stage CNS diseases. The findings may serve as valuable information for future HAL training of patients with CNS diseases.
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Affiliation(s)
- Masahiko Nishimura
- Department of Neurosurgery, Graduate School of Medicine, University of the Ryukyus
| | - Shigetaka Kobayashi
- Department of Neurosurgery, Graduate School of Medicine, University of the Ryukyus
| | - Yuki Kinjo
- Department of Neurosurgery, Graduate School of Medicine, University of the Ryukyus
| | - Yohei Hokama
- Department of Neurosurgery, Graduate School of Medicine, University of the Ryukyus
| | - Kenichi Sugawara
- Department of Neurosurgery, Graduate School of Medicine, University of the Ryukyus
| | - Yukio Tsuchida
- Department of Neurosurgery, Graduate School of Medicine, University of the Ryukyus
| | | | - Shogo Ishiuchi
- Department of Neurosurgery, Graduate School of Medicine, University of the Ryukyus
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Ali Abdelhamid Y, Cousins CE, Sim JA, Bellon MS, Nguyen NQ, Horowitz M, Chapman MJ, Deane AM. Effect of Critical Illness on Triglyceride Absorption. JPEN J Parenter Enteral Nutr 2015; 39:966-72. [PMID: 24963026 DOI: 10.1177/0148607114540214] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2014] [Accepted: 05/24/2014] [Indexed: 02/05/2023]
Abstract
BACKGROUND Adequate nutrition support for critically ill patients optimizes outcome, and enteral feeding is the preferred route of nutrition. Small intestinal glucose absorption is frequently impaired in critical illness. Despite lipid being a major constituent of liquid nutrient administered, there is little information about lipid absorption during critical illness. OBJECTIVES To determine small intestinal lipid, as well as glucose, absorption in critical illness compared with health. MATERIALS AND METHODS Twenty-nine mechanically ventilated critically ill patients and 16 healthy volunteers were studied. Liquid nutrient (60 mL, 1 kcal/mL), containing 200 µL (13)C-triolein and 3 g 3-O-methyl-glucose (3-OMG), was infused directly into the duodenum at a rate of 2 kcal/min. Exhaled (13)CO2 and serum 3-OMG concentrations were measured at timed intervals over 360 minutes. Lipid absorption was measured as the cumulative percentage dose (cPDR) of (13)CO2 recovered at 360 minutes. Glucose absorption was measured as the area under the 3-OMG concentration curve. Data are median (range) and analyzed using the Mann-Whitney U and Pearson correlation tests. RESULTS Lipid absorption was markedly less in the critically ill (cPDR(13)CO2: patients, 22.6% [0%-100%] vs healthy participants, 40.7% [5.3%-84.7%]; P = .018). While glucose absorption was less at 60 minutes in the critically ill (3-OMG60: 13.2 [3.5-29.5] vs 21.1 [9.3-31.9] mmol/L·min; P = .003), this was not apparent at 360 minutes (3-OMG360: 92.7 [54.5-147.9] vs 107.9 [64.0-168.7] mmol/L·min; P = .126). There was no relationship between lipid and glucose absorption. CONCLUSION Small intestinal absorption of lipid is diminished during critical illness.
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Affiliation(s)
| | - Caroline E Cousins
- Department of Critical Care Services, Royal Adelaide Hospital, Adelaide, Australia
| | - Jennifer A Sim
- Discipline of Acute Care Medicine, University of Adelaide, Adelaide, Australia
| | - Max S Bellon
- Department of Nuclear Medicine, Royal Adelaide Hospital, Adelaide, Australia
| | - Nam Q Nguyen
- Discipline of Medicine, University of Adelaide, Adelaide, Australia
| | - Michael Horowitz
- Discipline of Medicine, University of Adelaide, Adelaide, Australia
| | - Marianne J Chapman
- Department of Critical Care Services, Royal Adelaide Hospital, Adelaide, Australia Discipline of Acute Care Medicine, University of Adelaide, Adelaide, Australia
| | - Adam M Deane
- Department of Critical Care Services, Royal Adelaide Hospital, Adelaide, Australia Discipline of Acute Care Medicine, University of Adelaide, Adelaide, Australia
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Abstract
PURPOSE OF REVIEW To provide an overview on the recent literature regarding metabolism during sepsis and outcome-related effects of nutrition therapy in septic patients. The question when and how these patients should be fed with respect to macronutrient intake is elaborated. RECENT FINDINGS Although the incidence of severe sepsis has steadily increased over the past years, still no strong evidence is available with respect to the role of energy and protein provision in these patients. On the basis of recent large randomized trials in mixed patient populations, the updated sepsis guidelines recommend early but limited nutrition via the enteral route rather than targeted feeding. Lately, the results of a large trial challenged the importance of the route of feeding on the clinical outcome of critically ill patients. Four post-hoc analyses of prospective randomized trials including a large number of severely septic patients yielded conflicting results. One reported significant mortality reduction with near-target calorie and protein intake by exclusive enteral nutrition, whereas the second showed an advantage of enteral compared to combined nutrition, albeit resulting in a lower calorie and protein provision. The other two analyses found no association at all of either lower or higher daily caloric or protein intake, respectively, with clinical outcomes. SUMMARY In the absence of strong clinical evidence, pathophysiological findings are discussed and nutritional strategies for septic patients derived. Future studies should explore the individual response to specific exogenous supply of macronutrients and micronutrients in the acute and persistent phase of severe systemic inflammation.
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Affiliation(s)
- Gunnar Elke
- Department of Anaesthesiology and Intensive Care Medicine, University Medical Center Schleswig-Holstein, Campus Kiel, Kiel, Germany
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Halpern SD, Becker D, Curtis JR, Fowler R, Hyzy R, Kaplan LJ, Rawat N, Sessler CN, Wunsch H, Kahn JM. An Official American Thoracic Society/American Association of Critical-Care Nurses/American College of Chest Physicians/Society of Critical Care Medicine Policy Statement: The Choosing Wisely® Top 5 List in Critical Care Medicine. Am J Respir Crit Care Med 2014; 190:818-26. [DOI: 10.1164/rccm.201407-1317st] [Citation(s) in RCA: 104] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
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Eikermann M, Latronico N. What is new in prevention of muscle weakness in critically ill patients? Intensive Care Med 2013; 39:2200-3. [PMID: 24154675 DOI: 10.1007/s00134-013-3132-4] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2013] [Accepted: 10/04/2013] [Indexed: 01/17/2023]
Affiliation(s)
- Matthias Eikermann
- Department of Anesthesia, Critical Care and Pain Medicine at Massachusetts General Hospital, and Harvard Medical School, 55 Fruit Street, Boston, MA, 02115, USA,
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