Kiyotsugu takuma 14 , Kazuma Yamakawa 15 & the Japanese Association for Acute Medicine (JAAM) Sepsis prognostication in intensive care Unit and emergency Room (Spice) (JAAM Spice) Study Group* Systemic inflammatory response syndrome (SIRS) reportedly has a low performance for distinguishing infection from non-infection. We explored the distribution of the patients diagnosed by SIRS (SIRS patients) or a quick sequential organ failure assessment (qSOFA) (qSOFA patients) and confirmed the performance of the both for predicting ultimate infection after hospital admission. We retrospectively analyzed the data from a multicenter prospective study. When emergency physicians suspected infection, SIRS or the qSOFA were applied. The area under the receiver operating characteristic curves (AUC) was used to assess the performance of the SIRS and qSOFA for predicting established infection. A total of 1,045 patients were eligible for this study. The SIRS patients accounted for 91.6% of qSOFA patients and they showed a higher rate of final infection than that of non-SIRS patients irrespective of the qSOFA diagnosis. The AUCs for predicting infection with SIRS and a qSOFA were 0.647 and 0.582, respectively. The SIRS significantly predicted an ultimate infection (AUC, 0.675; p = 0.018) in patients who met the SIRS and qSOFA simultaneously. In conclusion, the SIRS patients included almost all qSofA patients. SiRS showed a better performance for predicting infection for qSofA in those who met both definitions. Since the announcement of the third international consensus definitions for sepsis and septic shock (Sepsis-3), much debate has been had on the accuracy of the quick sequential organ failure assessment (qSOFA) score for predicting mortality due to sepsis compared with the systemic inflammatory response syndrome (SIRS)

-125 - 破傷風に対する芍薬甘草湯 AbstractSuccessful treatment of tetanus using the herbal medicine shakuyakukanzoto: a report of three cases Tetanus can rapidly develop into muscle spasm accompanied by respiratory failure and result in fatal outcomes. Although the management of muscle spasticity and rigidity is of great importance, there is no consensus on the best treatment modality. Recently, the herbal medicine shakuyakukanzoto has been reported to be effective for the treatment of the muscle disorder in 2 patients with tetanus. Here, we report a comparison of 3 cases of tetanus that were successfully treated with shakuyakukanzoto with 3 cases treated without shakuyakukanzoto. All patients with tetanus presented with neck stiffness, dysphagia, and trismus, and received intravenous anti-tetanus human immunoglobulin and penicillin G with or without the oral administration of shakuyakukanzoto. Improvements in muscle spasticity and rigidity were found only in patients with shakuyakukanzoto, and not in those treated without: the latter needed to be managed with mechanical ventilation. Shakuyakukanzoto may be useful for the treatment of muscle spasticity and rigidity in patients with tetanus.

Background : In Japan, 44.3% of neonates are delivered in private clinics without an attending pediatrician. Obstetricians in the clinics must resuscitate asphyxiated neonates in unstable condition, such as respiratory failure, and they are frequently transferred to tertiary perinatal medical centers. There has been no study comparing the physiological status and prognosis of neonates transported by ambulance with those transported by helicopter. Methods: Medical and transport records were used to compare the physiological status of neonates transported to Kagoshima City Hospital by land and those transported by air between January 1, 2013, and December 31, 2017. Results : Data from 425 neonates transferred by land and 143 by air were analyzed. There were no significant differences between the two groups in mean gestational age, mean birthweight, fetal blood pH, Apgar score, or the Score for Neonatal Acute Physiology with Perinatal Extension-II (SNAPPE-II) on arrival to the tertiary center (16.3 AE 15.4 [95% confidence interval (CI): 13.2-17.7] vs 16.4 AE 15.4 [95% CI: 13.9-19.0], respectively; P = 0.999); both groups had SNAPPE-II score 10-19, indicating no difference in mortality risk. The times to starting first aid and to admission to the intensive care unit were significantly reduced in neonates transported by air than by land. In subgroup analysis of patients of a gestational age ≤28 weeks, all cases of severe intraventricular hemorrhage (IVH) were observed in the land transportation group. Conclusions: Neonatal transportation by air is as safe as land transportation, and time to first aid and intensive care are significantly reduced by transportation by air than by land. Air transport could also contribute to the prevention of IVH in neonatal transportation.

Background: NIRO-Pulse is a novel mode of near-infrared spectroscopy that can be used to visually evaluate cerebral perfusion during cardiopulmonary resuscitation (CPR), providing real-time feedback as to the quality of the CPR. The aim of this report was to describe the several representative cases of NIRO-Pulse for physiological monitoring during CPR. Methods: We present several cases from out-of-hospital cardiac arrest (OHCA) patients for whom NIRO-Pulse was attached to the forehead after hospital arrival. Patients were subjected to continuous brain monitoring during CPR using NIRO-Pulse, which allows for the visualisation of ΔHb (Hb pulsation). NIRO-Pulse is capable of simultaneously measuring and displaying cerebral tissue oxygen saturation (SctO2) and Hb pulsation, providing real-time feedback during CPR in the form of physiological indicators, and assessing changes in SctO2 throughout the CPR procedure by post-mortem analysis. Results: We observed several representative cases that provided the following insights: (1) SctO2 increased after a change in the quality of chest compression, (2) SctO2 decreased during the ventilation phase of synchronised CPR, (3) SctO2 decreased during the interruption of chest compressions for the preparation of defibrillation, and (4) SctO2 gradually and continuously increased after return of spontaneous circulation. Conclusion: Displaying Hb pulsation in conjunction with SctO2 during CPR may be helpful for evaluating the quality of and patient responsiveness to CPR. Further studies investigating the association between the use of NIRO-Pulse during CPR and subsequent outcomes should be conducted.