AimSubsyndromal delirium is associated with prolonged intensive care unit stays, and prolonged mechanical ventilation requirements. The Prediction of Delirium for Intensive Care (PRE‐DELIRIC) model can predict delirium. This study was designed to verify if it can also predict development of subsyndromal delirium.MethodsWe undertook a single‐center, retrospective observation study in Japan. We diagnosed subsyndromal delirium based on the Intensive Care Delirium Screening Checklist. We calculated the sensitivity and specificity of the PRE‐DELIRIC model and obtained a diagnostic cut‐off value.ResultsWe evaluated data from 70 patients admitted to the mixed medical intensive care unit of the Tokyo Medical University Hospital (Tokyo, Japan) between May 2015 and February 2017. The prevalence of subsyndromal delirium by Intensive Care Delirium Screening Checklist was 31.4%. The area under the receiver operating characteristic curve was 0.83 of the PRE‐DELIRIC model for subsyndromal delirium. The calculated cut‐off value was 36 points with a sensitivity of 94.3% and specificity of 57.1%. Subsyndromal delirium was associated with a higher incidence of delirium (odds ratio, 8.81; P < 0.01).ConclusionThe PRE‐DELIRIC model could be a tool for predicting subsyndromal delirium using a cut‐off value of 36 points.

Aim Pleural effusion is common among critically ill patients and associated with clinical consequences; however, the benefits of draining pleural effusion remain debatable. Thus, we aimed to investigate pleural drainage effectiveness by focusing on preprocedure patient status. Methods We retrospectively analyzed 22 patients with pleural effusion. Gas exchange, ventilator settings, vital signs, inflammatory response, and nutrition status were examined preprocedure and 24 h and 1 week postprocedure. Data were analyzed using the non‐parametric test and discriminant analysis with receiver operating characteristic curves. Results The partial arterial oxygen pressure (PaO 2 ) to fraction of inspiratory oxygen (F I O 2 ) (P/F) ratio at 24 h was higher postdrainage than predrainage (250 ± 87 versus 196 ± 84, P < 0.05); however, no significant difference between the P/F ratio predrainage and 1 week postdrainage was noted. Patients were classified into effective and ineffective groups according to a 110% increase in the P/F ratio 1 week postdrainage compared with predrainage. The predrainage P/F ratio was lower in the effective group than in the ineffective group (165 ± 91 versus 217 ± 74, P < 0.05). Discriminant analysis showed the area under the receiver operating characteristic curve was 0.72; the cut‐off value of the predrainage P/F ratio (divided into effective and ineffective groups) was 174. Conclusions Pleural drainage could be effective in patients who have lower preprocedure P/F ratios.

Aim:The spleen plays an important role in the immune response, and patients with impaired spleen function are at risk of overwhelming post-splenectomy infection. This study investigated whether the spleen volume could predict the prognosis of patients with bacteremia caused by encapsulated organisms.Methods: This was a single-center, retrospective observational study at Tokyo Medical University Hospital. Twenty patients with encapsulated bacteria (Streptococcus pneumoniae, Haemophilus influenzae, Neisseria meningitidis, and Capnocytophaga canimorsus) detected in blood culture between January 2017 and July 2020 were included in the study and categorized into two groups: survive and nonsurvive groups. We investigated the association between spleen volume (SV), spleen volume index (SVI), and inhospital mortality. The SVI was defined as: SVI-H, spleen volume cm 3 /height m; SVI-BW, spleen volume cm 3 /body weight kg; and SVI-A, spleen volume cm 3 9 age/100. Results:The number of patients in the survive group was 17, and that of the non-survive group was 3. The SV and SVI were smaller in the nonsurvive group than in the survive group (P < 0.05). The calculated the SV cut-off for the prediction of prognosis was 36 cm 3 with a sensitivity of 94.1% and specificity of 66.7% with a positive predictive value of 94.1% and a negative predictive value of 66.7%. Conclusions:The SV and SVI could be used to predict the prognosis of bacteremia caused by encapsulated organisms. If the spleen volume as measured by computed tomography is small, more intensive treatment should be considered.

This study aimed to determine whether obesity and disease outcomes are associated in patients with critically-ill coronavirus disease 2019 (COVID-19) requiring invasive mechanical ventilation (IMV). This retrospective observational study using Japanese multicenter registry data included COVID-19 patients who required IMV and were discharged between January and September 2020. The patients were divided into the obese (body mass index [BMI] ≥ 25 kg/m2) and nonobese (BMI < 25 kg/m2) groups. Logistic regression models were used to analyze the association between obesity and disease outcomes. The primary outcome was in-hospital mortality; the secondary outcome was venovenous extracorporeal membrane oxygenation (VV-ECMO) implementation. Altogether, 477 patients were enrolled (obese, n = 235, median BMI, 28.2 kg/m2; nonobese, n = 242, median BMI, 22.4 kg/m2). Obesity was significantly associated with lower in-hospital mortality in the unadjusted logistic regression model (odds ratio 0.63; 95% confidence interval, 0.42–0.97; p = 0.033), but not with mortality in the adjusted logistic regression model using age, sex, and Charlson Comorbidity Index as covariates (p = 0.564). Obesity was not associated with VV-ECMO implementation in both unadjusted and adjusted models (unadjusted, p = 0.074; adjusted, p = 0.695). Obesity was not associated with outcomes in COVID-19 patients requiring IMV. Obesity may not be a risk factor for poor outcomes in these patients.

Background: Hemodynamic stabilization is a core component in the resuscitation of septic shock. However, the optimal target blood pressure remains debatable. Previous randomized controlled trials suggested that uniformly adopting a target mean arterial pressure (MAP) higher than 65 mmHg for all adult septic shock patients would not be beneficial; however, it has also been proposed that higher target MAP may be beneficial for elderly patients, especially those with arteriosclerosis. Methods: A multicenter, pragmatic single-blind randomized controlled trial will be conducted to compare target MAP of 80–85 mmHg (High-target) and 65–70 mmHg (Control) in the resuscitation of septic shock patients admitted to 28 hospitals in Japan. Patients with septic shock aged ≥ 65 years are randomly assigned to the high-target or control groups. The target MAP shall be maintained for 72 h after randomization or until vasopressors are no longer needed to improve patients' condition. The primary outcome is all-cause mortality at 90 days after randomization. To minimize the adverse effects related to catecholamines, if norepinephrine dose of ≥0.1 µg/kg/min is needed to maintain the target MAP, vasopressin will be initiated. Other therapeutic approaches, including fluid administration, hydrocortisone use, and antibiotic choice, will be determined by the physician in charge based on the latest clinical guidelines.Discussion: The result of this trial will provide great insight on the resuscitation strategy for septic shock in the era of global aged society. Also, it will provide the better understanding on the importance of individualized treatment strategy in hemodynamic management in critically ill patients.Trial Registration: UMIN Clinical Trials Registry; UMIN000041775. Registered 13 September 2020.