岸原 悠貴

<h4>Objective</h4>To determine the association between timing of advanced airway management (AAM) and outcomes in witnessed pediatric out-of-hospital cardiac arrest (OHCA).<h4>Methods</h4>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.<h4>Results</h4>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)].<h4>Conclusion</h4>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.

<h4>Aim</h4>This study investigated the risk factors of peripheral intravenous catheter (PIVC)-related phlebitis in critically ill patients according to the duration of catheter dwelling.<h4>Methods</h4>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.<h4>Results</h4>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.<h4>Conclusion</h4>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.

<h4>Aim</h4>We aimed to investigate the appropriate timing for advanced airway management (AAM) in witnessed adult non-traumatic out-of-hospital cardiac arrest (OHCA) by adjusting for resuscitation time bias and limiting the analysis to witnessed OHCA.<h4>Methods</h4>This retrospective observational study used a multicentre OHCA registry involving 99 participating hospitals in Japan and included adult patients with witnessed non-traumatic OHCA who underwent AAM during resuscitation. The primary and secondary outcomes were favourable 30-day neurological outcomes and survival, respectively. The time from emergency medical service contact to AAM was categorised as follows: 1-5, 6-10, 11-15, 16-20, 21-25, and 26-30 min. In each group, we calculated the time-dependent propensity score using a Fine-Gray regression model. After propensity score matching, we used a generalised estimating equation (GEE).<h4>Results</h4>A total of 16,448 patients who underwent AAM were matched with patients at risk of requiring AAM. AAM was associated with favourable 30-day neurological outcomes when performed at 6-10 and 16-20 min with RRs (95% CIs) of 1.41 (1.12-1.78), but not at 16-20 min (0.74 [0.56-0.99]), respectively. AAM was associated with improved 30-day survival at 1-5 and 6-10 min (1.22 [1.05-1.41], 1.33 [1.16-1.54], respectively), but not at 16-20 min (0.78 [0.62-0.97].<h4>Conclusions</h4>Performing AAM within 10 min was associated with improved outcomes compared with those at risk of receiving AAM. However, the results were not consistent across all groups, therefore, careful interpretation is required.

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. We aimed to create guidelines that are easy to understand and use for physicians who recognize sepsis and provide initial management, specialized physicians who take over the treatment, and multidisciplinary healthcare providers, including nurses, physical therapists, clinical engineers, and pharmacists. The J-SSCG 2024 covers the following nine areas: diagnosis of sepsis and source control, antimicrobial therapy, initial resuscitation, blood purification, disseminated intravascular coagulation, adjunctive therapy, post-intensive care syndrome, patient and family care, and pediatrics. In these areas, we extracted 78 important clinical issues. The GRADE (Grading of Recommendations Assessment, Development and Evaluation) method was adopted for making recommendations, and the modified Delphi method was used to determine recommendations by voting from all committee members. As a result, 42 GRADE-based recommendations, 7 good practice statements, and 22 information-to-background questions were created as responses to clinical questions. We also described 12 future research questions.

<h4>Objectives</h4>In out-of-hospital cardiac arrest (OHCA), prehospital time is crucial and can be divided into response time, from emergency call to emergency medical service (EMS) contact, and time from EMS contact to hospital arrival. To improve prehospital strategies for pediatric OHCA, it is essential to understand the association between these time intervals and patient outcomes; however, detailed investigations are lacking. The current study aimed to examine the association between response time and time from EMS contact to hospital arrival as well as survival and neurological outcomes in pediatric OHCA.<h4>Methods</h4>This nationwide retrospective analysis used data from an OHCA registry in Japan between June 2014 and December 2021. Pediatric patients aged <18 years who had OHCA were included in the analysis. The primary outcome was 1-month survival, and the secondary outcome was 1-month favorable neurological outcome. Generalized additive model analyses and logistic regression analyses, adjusted for confounders, were performed to examine the non-linear and linear relationship between response time and patient care time (time from EMS contact with the patient to hospital arrival) and outcomes, respectively.<h4>Results</h4>In the generalized additive model analyses of response time, both survival and neurological outcomes worsened with response time, with outcomes appearing to further decline with a response time of approximately 15 minutes. On the other hand, there was a linear association between patient care time as well as 1-month survival and favorable neurologic outcomes. In logistic regression analyses, shorter response times were significantly associated with survival (odds ratio [OR]: 0.83, 95% confidence interval [CI]: 0.79-0.91]) and a favorable neurological outcome (OR: 0.75, 95% CI: 0.59-0.93). In contrast, time from EMS contact to hospital arrival was not significantly associated with survival (OR: 0.99, 95% CI: 0.97-1.02) and favorable neurological outcomes (OR: 1.02, 95% CI: 0.97-1.07).<h4>Conclusions</h4>A response time of <15 minutes can be associated with better survival and neurological outcomes. However, there is no significant association between time from EMS contact to hospital arrival as well as survival and favorable neurological outcomes.