安田 英人

Abstract Aim of the study The rupture of delayed formed splenic pseudoaneurysms after pediatric blunt splenic injuries undergoing nonoperative management (NOM) can be life-threatening. We aimed to identify the sub-phenotypes predicting delayed splenic pseudoaneurysm formation following pediatric blunt splenic injury using latent class analysis (LCA). Material and Methods In this retrospective observational study conducted using a multicenter cohort of pediatric trauma patients, we included pediatric patients (aged ≤16 years) who sustained blunt splenic injuries and underwent NOM from 2008 to 2019. LCA was performed using clinically important variables, and 2–5 sub-phenotypes were identified. The optimal number of sub-phenotypes was determined on the basis of clinical importance and Bayesian information criterion. The association between sub-phenotyping and delayed splenic pseudoaneurysm formation was analyzed using univariate logistic regression analysis with odds ratios (ORs) and 95% confidence intervals (CIs). Results The LCA included 434 patients and identified three optimal sub-phenotypes. Contrast extravasation (CE) of initial CT in the spleen was observed in 22 patients (68.8%) in Sub-phenotype 1, 49 patients (25.7%) in Sub-phenotype 2, and 22 patients (10.4%) in Sub-phenotype 3 (p = 0.007). Delayed splenic pseudoaneurysm was observed in 46 patients (10.6%), including seven patients (21.9%) in Sub-phenotype 1, 25 patients (13.1%) in Sub-phenotype 2, and 14 patients (6.6%) in Sub-phenotype 3 (p = 0.01). Logistic regression analysis for delayed splenic pseudoaneurysm formation using Sub-phenotype 3 as the reference revealed an OR (95% CI) of 3.94 (1.45–10.7) in Sub-phenotype 1 and 2.12 (1.07–4.21) in Sub-phenotype 2. Conclusions The LCA identified three sub-phenotypes showing statistically significant differences for delayed splenic pseudoaneurysm formation. Our findings suggest that cases with CE on initial CT imaging may be at increased risk of delayed splenic pseudoaneurysm formation.

OBJECTIVE: To determine the association between timing of advanced airway management (AAM) and outcomes in witnessed pediatric out-of-hospital cardiac arrest (OHCA). METHODS: We performed a retrospective cohort study using data from the OHCA registry in Japan. We included pediatric patients (<18 y) with OHCA who received AAM. We compared patients who received AAM at 1 to 10, 11 to 20, and 21 to 30 minutes after emergency medicine service (EMS) contact with the patient with those who had not yet received AAM but remained eligible to receive it at those times, respectively. The primary and secondary outcome measurements were survival and favorable neurological outcome at 1 month, respectively. To address resuscitation time bias, we performed risk-set matching analyses using time-dependent propensity score. RESULTS: A total of 269 patients were included. The numbers receiving AAM in each time period were 60 in the 1 to 10 minute period, 83 in the 11 to 20 minute period, and 84 in the 21 to 30 minute period. The association between patients who received AAM in each time period and survival was compared with patients who had not yet received AAM but remained eligible to receive it in that time period: 1 to 10 minutes [risk ratio (RR): 2.12 (95% CI: 0.61-7.33)], 11 to 20 minutes [RR: 3.03 (95% CI: 1.13-8.12)], and 21 to 30 minutes [RR: 0.95 (95% CI: 0.46-1.96)]. The association with favorable neurological outcomes: 1 to 10 minutes [RR: 2.47 (95% CI: 0.42-14.56)], 11 to 20 minutes [RR: 2.54 (95% CI: 0.63-10.23)], 21 to 30 minutes [RR: 0.86 (95% CI: 0.25-2.99)]. CONCLUSION: In witnessed pediatric OHCA patients who went on to receive AAM, receiving this treatment in the time interval of 11 to 20 minutes was associated with survival, while earlier and later AAM times showed no association. Meanwhile, no association with favorable neurological outcomes was observed.

AIM: This study investigated the risk factors of peripheral intravenous catheter (PIVC)-related phlebitis in critically ill patients according to the duration of catheter dwelling. METHODS: This was a post-hoc analysis of the AMOR-VENUS study involving 23 intensive care units (ICUs) in Japan. We included patients aged ≥ 18 admitted to the ICU and had PIVCs inserted during ICU admission. The primary outcome measure was phlebitis, and the risk factors of phlebitis were evaluated based on hazard ratios (HR) and 95% confidence intervals (CI). The duration of catheter dwelling was classified as (i) ≤ 24 h; (ii) > 24 h, ≤ 72 h; and (iii) > 72 h. Multivariable marginal Cox regression analysis was performed using the presumed risk factors for each group. RESULTS: In total, 1,335 patients and 3,348 PIVCs were evaluated. Among patients with ≤ 24 h of catheter dwelling, phlebitis occurrence was associated with ICU admission for non-surgical management with ICU admission for elective surgery as the reference, standardized drug administration in the ICU, and dexmedetomidine administration in the ICU. Among those with > 24 h but ≤ 72 h of catheter dwelling, it was associated with male sex with female sex as the reference, tetrafluoroethylene as the catheter material with polyurethane as the reference, nicardipine administration, and noradrenaline administration. Among those with > 72 h of catheter dwelling, it was associated with a catheter size ≥ 18 G and nicardipine administration. CONCLUSION: The risk factors for phlebitis varied with the duration of catheter dwelling. Individualized catheter management, considering the duration of catheter dwelling, may help avoid phlebitis in patients admitted to the ICU.