齋藤 大之

BACKGROUND: ICU admission rates after Rapid Response System (RRS) activation vary widely across institutions. This study examined institutional differences in ICU admission rates and their association with outcomes. METHODS: A multicenter retrospective observational study was conducted using a Japanese in-hospital emergency registry, including patients with RRS activation between 2018 and 2022. We calculated the ICU admission rate (ICU admissions/RRS activations) and the Standardized ICU Admission Ratio (SIAR; actual/predicted ICU admissions) for each of 35 participating institutions. The association between SIAR and outcomes was assessed using generalized estimating equation logistic regression with hospital-level clustering. The primary outcome was "death within 30 days", and the secondary outcome was a composite of "Cerebral Performance Category (CPC) ≥ 3 or death within 30 days". Outcomes were defined as events occurring during hospitalization, within a maximum of 30 days following RRS activation. RESULTS: The study included 8,794 patients. The median ICU admission rate was 0.33 (IQR, 0.21-0.47), and the median SIAR was 0.98 (IQR, 0.75-1.17). In univariable analysis, SIAR showed a non-significant association with the incidence of "death within 30 days" (β = -0.05, 95% CI [-0.12, 0.01]; P = 0.108) and a significant negative association with the incidence of "CPC ≥ 3 or death within 30 days" (β = -0.15, 95% CI [-0.27, -0.03]; P = 0.015). In multivariable analysis, a 0.1-unit increase in SIAR was associated with an odds ratio of 0.98 (95% CI, 0.97-0.99; P = 0.104) for "death within 30 days", and 0.94 (95% CI, 0.92-0.96; P < 0.001) for "CPC ≥ 3 or death within 30 days". CONCLUSIONS: Higher SIAR values were significantly associated with a lower incidence of "CPC ≥ 3 or death within 30 days". Greater ICU utilization after RRS activation may improve outcomes, though underlying mechanisms require further study.

BACKGROUND: One-lung ventilation (OLV) is an essential technique in thoracic surgery, and double-lumen endobronchial tubes (DLTs) are commonly used. While right-sided DLTs are useful in specific situations, few studies have investigated the prevalence of their use. This study aimed to investigate the current practice of OLV and right-sided DLT usage among anesthesiologists in Japan. METHODS: A nationwide cross-sectional survey was conducted in September 2024, targeting 1444 hospitals certified by the Japanese Society of Anesthesiologists. Questionnaires were mailed to anesthesiology departments, inquiring about OLV practices, right-sided DLT usage, challenges, and desired improvements. Responses were collected via postal mail or web, and data were analyzed using descriptive statistics and Chi-square tests. RESULTS: A total of 768 institutions responded (response rate: 53.2%). Among 761 valid responses, 74.9% performed OLV, and DLTs were the most frequently used device (94.7%). Approximately half (45.8%) of the institutions performing OLV reported never using right-sided DLTs. Frequently recognized challenges included insertion difficulty, positioning difficulty, and unfamiliarity, and 42.1% of institutions expressed a willingness to increase the use of right-sided DLTs if these challenges were resolved. Institutions with a higher annual volume of OLV cases tended to use right-sided DLTs more frequently, but the proportion of institutions unfamiliar with right-sided DLTs was not associated with the number of OLV cases performed. CONCLUSION: OLV is widely practiced in Japan, primarily using DLTs, while the use of right-sided DLTs is limited. Concerns over technical difficulties and complications may hinder the use of right-sided DLTs.

To improve severe ketoacidosis with COVID-19, insulin treatment, invasive mechanical ventilation therapy, and continuous hemodiafiltration with sodium bicarbonate infusion were effective.