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.

A 55-year-old man (body mass index, 58) was transported to our emergency room for dyspnea. Cardiac ultrasonography (Fig. 1A) was carried out, and a high-intensity mass lying across the foramen ovale was displayed. The edge of the mass was going back and forth between the left ventricle and atrium (Video S1). There was no deep vein thrombosis on contrast-enhanced computed tomography. The patient was diagnosed as having pulmonary embolism and thromboembolism-in-transit across a patent foramen ovale. A massive thrombus was found to be moving to the left atrium, which indicated a very critical state, and open thrombectomy was performed. Transesophageal echography during surgery also displayed a thrombus trapped in the foramen ovale (Fig. 1B), and a giant thrombus, 20 cm long, was removed (Fig. 1C).

Study Objectives: To determine patient characteristics associated with requiring hospital admission from an emergency department observation unit (OU).