[Passive Orthostatism Using Tilt Table in Critical Patients after Cardiovascular Surgery].

Previously, we performed passive orthostatism using a tilt table for the purpose of early mobilization in intensive care unit patients after cardiovascular surgery. In this study, we introduced VitalGo Total Lift Bed( TLB), which does not require patient-transfer before passive orthostatism, to reduce the burden on patients and medical staff. No obvious adverse events were found throughout the study. In the TLB group, number of medical staff required to perform the passive orthostatism was significantly less compared to the conventional tilt table group.

[Passive Orthostatism Using a Tilt Table in Patients with Impaired Oxygenation after Cardiovascular Surgery].

Passive orthostatism using a tilt table was introduced in patients with impaired oxygenation [Pao2/Fio(2 P/F) ratio < 300] after cardiovascular surgery. Our passive orthostatism protocol was as follows. Patient was transferred to a tilt table under endotracheal intubation with pulmonary artery catheter monitoring, and rested for 10 minutes in a supine position, followed by 45-degree tilt for 5 minutes, and then passive orthostatism at 60-degree for 25 minutes. P/F ratio was significantly improved during passive orthostatism. Improvement in P/F ratio was confirmed even 1 hour after completion of the protocol. No obvious adverse events were found throughout the protocol. On average, 15 hours (2~72 hours, median 4 hours) after the introduction of passive orthostatism, weaning from respirator was achieved.

[Thoracentesis under Standing with Assistance of a Tilt Table in Critical Patients after Cardiovascular Surgery].

For safe and effective drainage in patients with pleural effusion after cardiac surgery, ultrasound-guided thoracocentesis was carried out under standing with assistance of a tilt table. Thoracocentesis was performed in 5( 11%) of the 44 patients who were treated under passive orthostatism using a tilt table. Four cases were under intubated-ventilator assist, and 2 cases were under intraaortic balloon pumping( IABP). No adverse events occurred. Thoracocentesis under standing with assistance of a tilt table can be safely performed.

Effectiveness of early high-flow nasal oxygen therapy after extubation of patients in the intensive care unit.

PURPOSE: This study aimed to evaluate the impact of early high-flow nasal oxygen (HFNO) therapy initiation using a pre-determined respiratory rate­oxygenation (ROX) index on reducing reintubation rates and duration of intensive care unit (ICU) stay in post-extubated patients. MATERIALS AND METHODS: We enrolled a total of 145 extubated patients (mean age: 67.1 ± 12.9 years; sex: 96 male and 49 female; acute physiology and chronic health evaluation II score: 18.4 ± 6.8 points) classified into two groups: 71 patients admitted to the ICU before establishing extubation criteria and 74 patients after criteria implementation, over a 6-month period. We compared the HFNO reintubation rates and ROX index at 2 h post-extubation before and after implementing early HFNO criteria. RESULTS: The utilization rate of HFNO pre- and post-establishment of early HFNO criteria did not differ significantly (19.7% vs. 17.6%). However, the reintubation rate significantly decreased (11.3% vs. 4.1%, P < 0.05) with early HFNO use. Additionally, significant differences were observed in the total intubation period (5.2 ± 7.0 vs. 2.5 ± 2.7 days, P < 0.05) and ICU duration (8.6 ± 9.7 vs. 5.8 ± 5.6 days, P < 0.05). CONCLUSIONS: Early initiation of HFNO guided by the ROX index threshold post-extubation in patients admitted to ICU is associated with reduced reintubation rates and shorter ICU stays.

Development of pulmonary arterial hypertension following long-term Qing-Dai use for ulcerative colitis.

A 20-year-old woman using Qing-Dai for about 7 years for intractable ulcerative colitis was admitted to the emergency room because of dyspnea and syncope following exertion. The patient was diagnosed with drug-induced pulmonary arterial hypertension (PAH). Discontinuation of Qing-Dai rapidly improved PAH symptoms. The REVEAL 2.0 risk score, which is useful for assessing the severity of PAH and predicting prognosis, improved from high risk (12) to low risk (4) within 10 days. Discontinuing long-term use of Qing-Dai can rapidly improve Qing-Dai-induced PAH. Learning objective: Discontinuing the long-term use of Qing-Dai used for treating ulcerative colitis (UC) can rapidly improve Qing-Dai induced pulmonary arterial hypertension (PAH). REVEAL 2.0 risk score in patients who developed PAH due to Qing-Dai was useful for screening PAH in patients taking Qing-Dai for treatment of UC.

Evaluating the one-time chair stand test for predicting the coronavirus disease severity in patients during hospital admission: a cohort study in Japan.

BACKGROUND: This study aimed to understand whether the one-time chair stand test (CS-1) is useful for predicting the severity of coronavirus disease (COVID-19) in 101 patients admitted to the hospital with acute respiratory failure. METHODS: This single-centered, prospective observational cohort study enrolled 101 critically ill adult patients hospitalized with COVID-19 who underwent the CS-1 as a dynamic evaluation tool in clinical practice between late April 2020 and October 2021. Data on demographic characteristics, symptoms, laboratory values, computed tomography findings, and clinical course after admission were collected. Furthermore, the data was compared, and the association between the intubation and non-intubation groups was determined. We also calculated the cutoff point, area under the curve (AUC), and 95% confidence interval (CI) of the change in oxygen saturation (ΔSpO2) during the CS-1. RESULTS: Thirty-three out of 101 patients (33%) were intubated during hospitalization. There was no significant difference in the resting SpO2 (93.3% versus 95.2%, P = 0.22), but there was a significant difference in ΔSpO2 during the CS-1 between the intubation and non-intubation groups (10.8% versus 5.5%, P < 0.01). In addition, there was a significant correlation between hospitalization and ΔSpO2 during the CS-1 (ρ = 0.60, P < 0.01). The generated cutoff point was calculated as 9.5% (AUC = 0.94, 95% CI = 0.88-1.00). CONCLUSION: For COVID-19 patients with acute respiratory failure, the CS-1 performed on admission was useful for predicting the severity of COVID-19. Furthermore, the CS-1 can be utilized as a remote and simple evaluation parameter. Thus, it could have potential clinical applications in the future.

Relative bradycardia in patients with moderate-to-severe COVID-19: a retrospective cohort study.

Coronavirus-related disease (COVID-19) can result in relative bradycardia; however, there are no reports on relative bradycardia in patients with moderate-to-severe COVID-19 who require oxygen. We retrospectively investigated 45 patients with moderate-to-severe COVID-19 and examined the relationship between heart rate and body temperature at the time of initiating oxygen or mechanical ventilation. For three consecutive days after initiating oxygen therapy, body temperature (day's highest temperature), heart rate, and other vital signs were measured simultaneously. We checked for relative bradycardia and analyzed the differences between patients with moderate COVID-19 (oxygen requirement ≤ 5 L/min) and those with severe COVID-19 (oxygen requirement ≥ 5 L/min). Of the 45 patients, 28 and 17 had moderate and severe COVID-19, respectively. The heart rate increased with increasing body temperature, and almost all patients satisfied the criteria of relative bradycardia. In Spearman's rank correlation analysis, body temperature was significantly correlated with heart rate (ρ = 0.483, p = 0.012) in moderately ill patients but not in severely ill patients (ρ = 0.261, p = 0.297). Multiple regression analysis revealed that the severity of COVID-19 and body temperature were independent predictors of heart rate. The predicted change in heart rate was 6.0 beats/min for each 1 °C rise in body temperature. Relative bradycardia was suggested to be a characteristic finding in patients with moderate-to-severe COVID-19 who require oxygen. Additionally, severely ill patients were more likely to develop relative bradycardia than moderately ill patients. Focusing on the relationship between heart rate and body temperature might help clinicians diagnose this disease in patients with worsening respiratory failure.