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Yamakagashi (Rhabdophis tigrinus) is a widely distributed snake species in Japan. Yamakagashi causes venom-induced consumption coagulopathy (VICC) when the amount of infused venom is high, and bites can be fatal if antivenom treatment is delayed. However, yamakagashi antivenom is an unapproved treatment, and its storage capacity is limited, preventing its prompt administration. Therefore, we investigated the application of commercially available drugs, namely tranexamic acid and antithrombin III, in the treatment of VICC caused by yamakagashi venom in a rat model. Furthermore, we investigated the combination of each drug with recombinant thrombomodulin α. Administration of tranexamic acid or antithrombin III alone failed to extend rat survival or correct changes in blood coagulation markers, such as prothrombin time, fibrinogen concentrations, and D-dimer levels, in yamakagashi venom-treated rats. However, combined administration of recombinant thrombomodulin α and tranexamic acid extended rat survival and partially restored blood coagulation markers. Therefore, the combination of recombinant thrombomodulin α and tranexamic acid might represent a useful therapeutic regimen for yamakagashi venom exposure.

Background Heat stroke is a life-threatening injury requiring neurocritical care; however, heat stroke has not been completely examined due to several possible reasons, such as no universally accepted definition or classification, and the occurrence of heat wave victims every few years. Thus, in this review, we elucidate the definition/classification, pathophysiology, and prognostic factors related to heat stroke and also summarize the results of current studies regarding the management of heat stroke, including the use of intravascular balloon catheter system, blood purification therapy, continuous electroencephalogram monitoring, and anticoagulation therapy. Main body Two systems for the definition/classification of heat stroke are available, namely Bouchama’s definition and the Japanese Association for Acute Medicine criteria. According to the detailed analysis of risk factors, prevention strategies for heat stroke, such as air conditioner use, are important. Moreover, hematological, cardiovascular, neurological, and renal dysfunctions on admission are associated with high mortality, which thus represent the potential targets for intensive and specific therapies for patients with heat stroke. No prospective, comparable study has confirmed the efficacy of intravascular cooling devices, anticoagulation, or blood purification in heat stroke. Conclusion The effectiveness of cooling devices, drugs, and therapies in heat stroke remains inconclusive. Further large studies are required to continue to evaluate these treatment strategies.

Expanding elderly populations are a major social challenge in advanced countries worldwide and have led to a rapid increase in the number of elderly patients in intensive care units (ICUs). Innovative advances in medical technology have enabled lifesaving of patients in ICUs, but there remain various problems to improve their long‐term prognoses. Post‐intensive care syndrome (PICS) refers to physical, cognition, and mental impairments that occur during ICU stay, after ICU discharge or hospital discharge, as well as the long‐term prognosis of ICU patients. Its concept also applies to pediatric patients (PICS‐p) and the mental status of their family (PICS‐F). Intensive care unit‐acquired weakness, a syndrome characterized by acute symmetrical limb muscle weakness after ICU admission, belongs to physical impairments in three domains of PICS. Prevention of PICS requires performance of the ABCDEFGH bundle, which incorporates the prevention of delirium, early rehabilitation, family intervention, and follow‐up from the time of ICU admission to the time of discharge. Diary, nutrition, nursing care, and environmental management for healing are also important in the prevention of PICS. This review outlines the pathophysiology, prevention, and future directions of PICS. Conceptual framework of post‐intensive care syndrome (PICS). ICU, intensive care unit; PICS‐F, PICS – family.

Families of critically ill patients are predisposed to tremendous burdens when their relatives are admitted to the intensive care unit (ICU). Postintensive care syndrome family (PICS‐F) can be described as a devastated life, encompassing psychological, physical, and socioeconomical burdens that begin with the emotional impact experienced by the family when the patient is admitted to the ICU. PICS‐F was primarily proposed as a clinically significant psychological impairment, but it needs to be extended beyond the psychological impairment of the family to include physical and socioeconomical impairments in the future. The prevalence of physiological problems including depression, anxiety and post‐traumatic syndrome is 20–40%, and that of non‐physiological problems including fatigue is 15% at 6 months after the ICU stay. Assessment of PICS‐F was frequently conducted at 3‐ or 6‐month points, although the beginning of the evaluation was based on different assessment points among each of the studies. Families of ICU patients need to be given and understand accurate information, such as the patient's diagnosis, planned care, and prognosis. Prevention of PICS‐F requires a continuous bundle of multifaceted and/or multidisciplinary interventions including providing a family information leaflet, ICU diary, communication facilitators, supportive grief care, and follow‐up, for the patient and families from during the ICU stay to after discharge from the ICU. This is the first comprehensive review of PICS‐F to address the concept, risk factors, assessment tools, prevalence, and management to prevent PICS‐F to facilitate acute care physicians' understanding of PICS‐F. Postintensive care syndrome family (PICS‐F) is grave, which is a psychological, physical, and socioeconomic disorder of the family after the patient is admitted to the ICU that has a major impact on the quality of life of the families and the ability to support the recovery of ICU patients.

Keywords: Extracorporeal cardiopulmonary resuscitation, Out-of-hospital cardiac arrest, Neurological outcome, Survival rate, Cardiac, Targeted temperature management

Background After the strict visitation restrictions during the COVID-19 pandemic, the value of family presence has been re-emphasized as an essential part of patient- and family-centred care in the intensive care unit (ICU). The aim of this study was to investigate the status of family presence policies and waiting room conditions in Japanese ICUs. Methods A cross-sectional survey of 292 hospitals certified as tertiary medical centres in Japan was performed using a combination of postal and web-based questionnaires. This included 12 questions about institutional characteristics, family presence policies, and waiting room facilities. Results Of the 292 tertiary medical centres contacted, 151 (51.7%) responded. Of these, 120 institutions (79.5%) restricted family visiting hours, typically limited to several hours in the afternoon and limited the number of family members at the same time. These restrictions were often relaxed in cases of sudden clinical deterioration or near the end of the patient’s life. In addition, 144 institutions (95.4%) had family waiting rooms for ICUs, and most provided Table (76.4%) and chairs (96.5%). However, only a few offered amenities such as books and magazines (13.9%), napping areas (10.4%), cooking facilities (3.5%), shower rooms (2.1%), or refrigerators (0.7%). Moreover, only 47 institutions (32.6%) ensured adequate privacy in their waiting rooms. There were no significant differences in the family presence policies or waiting room conditions depending on the number of ICU beds, except for the location of the family waiting room. Conclusions Most ICUs in Japan restricted family visiting hours to several hours in the afternoon and limited the number of family members at the same time. Moreover, family waiting rooms often lack essential amenities and do not sufficiently protect privacy.

Keywords: COVID-19, Adverse events, Nafamostat mesylate, Favipiravir

In this study, we aimed to develop and validate a machine learning-based mortality prediction model for hospitalized heat-related illness patients. After 2393 hospitalized patients were extracted from a multicentered heat-related illness registry in Japan, subjects were divided into the training set for development (n = 1516, data from 2014, 2017–2019) and the test set (n = 877, data from 2020) for validation. Twenty-four variables including characteristics of patients, vital signs, and laboratory test data at hospital arrival were trained as predictor features for machine learning. The outcome was death during hospital stay. In validation, the developed machine learning models (logistic regression, support vector machine, random forest, XGBoost) demonstrated favorable performance for outcome prediction with significantly increased values of the area under the precision-recall curve (AUPR) of 0.415 [95% confidence interval (CI) 0.336–0.494], 0.395 [CI 0.318–0.472], 0.426 [CI 0.346–0.506], and 0.528 [CI 0.442–0.614], respectively, compared to that of the conventional acute physiology and chronic health evaluation (APACHE)-II score of 0.287 [CI 0.222–0.351] as a reference standard. The area under the receiver operating characteristic curve (AUROC) values were also high over 0.92 in all models, although there were no statistical differences compared to APACHE-II. This is the first demonstration of the potential of machine learning-based mortality prediction models for heat-related illnesses.

Background The assessment of post-intensive care syndrome (PICS) is challenging due to the numerous types of instruments. We herein attempted to identify and propose recommendations for instruments to assess PICS in intensive care unit (ICU) survivors. Methods We conducted a scoping review to identify PICS follow-up studies at and after hospital discharge between 2014 and 2022. Assessment instruments used more than two times were included in the modified Delphi consensus process. A modified Delphi meeting was conducted three times by the PICS committee of the Japanese Society of Intensive Care Medicine, and each score was rated as not important (score: 1–3), important, but not critical (4–6), and critical (7–9). We included instruments with ≥ 70% of respondents rating critical and ≤ 15% of respondents rating not important. Results In total, 6972 records were identified in this scoping review, and 754 studies were included in the analysis. After data extraction, 107 PICS assessment instruments were identified. The modified Delphi meeting reached 20 PICS assessment instrument recommendations: (1) in the physical domain: the 6-min walk test, MRC score, and grip strength, (2) in cognition: MoCA, MMSE, and SMQ, (3) in mental health: HADS, IES-R, and PHQ-9, (4) in the activities of daily living: the Barthel Index, IADL, and FIM, (5) in quality of life: SF-36, SF-12, EQ-5D-5L, 3L, and VAS (6), in sleep and pain: PSQI and Brief Pain Inventory, respectively, and (7) in the PICS-family domain: SF-36, HADS, and IES-R. Conclusion Based on a scoping review and the modified Delphi method, 20 PICS assessment instruments are recommended to assess physical, cognitive, mental health, activities of daily living, quality of life, sleep, and pain in ICU survivors and their families.

Post‐intensive care syndrome comprises physical, cognitive, and mental impairments in patients treated in an intensive care unit (ICU). It occurs either during the ICU stay or following ICU discharge and is related to the patients' long‐term prognosis. The same concept also applies to pediatric patients, and it can greatly affect the mental status of family members. In the 10 years since post‐intensive care syndrome was first proposed, research has greatly expanded. Here, we summarize the recent evidence on post‐intensive care syndrome regarding its pathophysiology, epidemiology, assessment, risk factors, prevention, and treatments. We highlight new topics, future directions, and strategies to overcome post‐intensive care syndrome among people treated in an ICU. Clinical and basic research are still needed to elucidate the mechanistic insights and to discover therapeutic targets and new interventions for post‐intensive care syndrome. Post‐intensive care syndrome (PICS) includes physical, cognitive, and mental impairments that occur during ICU stay or following ICU discharge as well as the long‐term prognosis of ICU patients. This review summarizes the outline of PICS, including chronic pain, risk factors, and assessment, as well as recent evidence of the prevention and treatment of PICS. Furthermore, looking ahead to the next decade, this review highlights the potential of ICU telemedicine, support for the return to work, and community health care toward the social reintegration of patients with PICS.