BackgroundOlder patients account for the majority of patients with sepsis. The objective of this study was to determine if decreased skeletal muscle mass is associated with outcomes in elderly patients with sepsis.MethodsPatients (60 years and older) who were admitted to a tertiary medical center intensive care unit with a primary diagnosis of sepsis between January 2012 and February 2016 were included. Patients who had not undergone abdominal computed tomography on the day of admission, had cardiopulmonary arrest on arrival, or had iliopsoas abscess were excluded from the analyses. Cross-sectional muscle area at the 3rd lumber vertebra was quantified, and the relation to in-hospital mortality was analyzed. Multivariable logistic regression analysis that included sex and APACHE II score as explanatory variables was performed. The optimal cutoff value to define decreased muscle mass (sarcopenia) was calculated using receiver operating characteristic curve analysis, and the odds ratio for in-hospital mortality was determined.ResultsThere were 150 elderly patients with sepsis (median age, 75 years) enrolled; in-hospital mortality and median APACHE II score were 38.7 and 24%, respectively. The skeletal muscle area of deceased patients was significantly lower than that of the survival group (P < 0.001). The multivariable logistic regression analysis demonstrated that decreased muscle mass was significantly associated with increased mortality (odds ratio = 0.94, 95% confidence interval = 0.90 to 0.97, P < 0.001). The optimal cutoff value of skeletal muscle area to predict in-hospital mortality was 45.2 cm2 for men and 39.0 cm2 for women. With these cutoff values, the adjusted odds ratio for decreased muscle area was 3.27 (95% CI, 1.61 to 6.63, P = 0.001).ConclusionsLess skeletal muscle mass is associated with higher in-hospital mortality in elderly patients with sepsis. The results of this study suggest that identifying patients with low muscularity contributes to better stratification in this population.

The optimal timing of tracheostomy in patients with traumatic brain injury (TBI) remains unclear. The purpose of this study was to examine the effects of tracheostomy performed within 72 h after admission. In this retrospective cohort study, the authors reviewed the data for a series of 120 consecutive patients who underwent tracheostomy after suffering TBI with an Abbreviated Injury Scale (AIS) score of ≥4. The exclusion criteria were as follows: age <18 years, severe chest injury with an AIS score of ≥4, and a requirement for intubation because of upper airway obstruction. Patients who underwent tracheostomy ≤72 h and >72 h after admission were classified into early group and control groups, respectively. The duration of mechanical ventilation, length of stay (LOS) in intensive care unit (ICU), incidence of pneumonia, adverse event rate, unnecessary tracheostomy and outcomes were compared between the two groups. Of the 120 patients, 29 were excluded from the study, 40 were classified into the early group, and 51 were classified into the control group. The duration of mechanical ventilation and LOS in ICU were significantly less in the early group than in the control group. The 30-day mortality rates were 3% and 8% for the early and control groups, respectively. There was no significant difference in the adverse event rate, incidence of pneumonia, unnecessary tracheostomy rate and the rate of favorable outcome between groups. The results of this study suggest that the performance of tracheostomy within 72 h of admission may decrease the duration of mechanical ventilation and LOS in ICU, with acceptable mortality and morbidity rates.

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Microvascular decompression (MVD) is effective for the relief of symptoms, but little is known about the impact of the MVD procedure on patient's quality of life (QoL) or which QoL factors are important. The surgical results of MVD and the impact of this procedure were evaluated on patient's QoL in 139 patients, 74 with hemifacial spasm (HFS) and 65 with trigeminal neuralgia (TN), who underwent MVD between 2004 and 2011 using the 36-Item Short Form Health Survey questionnaire. Symptoms had resolved in approximately 95% of patients after MVD. The QoL questionnaire was completed by 54 HFS patients and 38 TN patients. Although long-term QoL scores for both groups were comparable to the average national value, scores related to physical role, emotional role, and social function were significantly lower for patients within 12 months of receiving MVD for HFS, compared with the reference scores. Symptomatic improvements and complications were correlated with the QoL scores related to the social function domain for patients with HFS. No other significant relationships were observed between any of the factors or scores in any of the respective domains or periods. Subjective symptoms were the main self-reported causes of delayed recovery of QoL domains. Some QoL domains take a long time to recover and postoperative subjective symptoms might be major causes in addition to delayed relief of symptoms.