Review of remimazolam and sedatives in the intensive care unit

Remimazolam is a novel intravenous ultra-short acting benzodiazepine that has the potential of being a safe and effective new sedative for use in intensive care unit (ICU) settings. Because remimazolam metabolizes rapidly by being hydrolyzed to an inactive metabolite (CNS 7054) through non-specific tissue esterase activity, specific dosing adjustment for older adults and for patients with renal or hepatic impairment patients (except for those with severe hepatic impairment) is not required. In addition, research has shown that remimazolam may be reversed by administration of flumazenil, as its half time was sufficiently short compared to flumazenil. It shows a lower incidence of cardiorespiratory depression, less injection pain, and no fatal complications such as propofol infusion syndrome and malignant hyperthermia of inhalational anesthetics. Future studies to study the suitability of remimazolam for managing the sedation of ICU patients who need sedation for a long time over several days is required

Factors associated with delirium among survivors of acute respiratory distress syndrome: a nationwide cohort study

Background The prevalence of delirium, its associated factors, and its impact on long-term mortality among survivors of acute respiratory distress syndrome (ARDS) is unclear. Methods Since this was a population-based study, data were extracted from the National Health Insurance database in South Korea. All adults who were admitted to intensive care units with a diagnosis of ARDS between January 1, 2010, and December 31, 2019, and who survived for ≥ 60 days were included. The International Statistical Classification of Diseases and Related Health Problems, tenth revision code of delirium (F05) was used to extract delirium cases during hospitalization. Results A total of 6809 ARDS survivors were included in the analysis, and 319 patients (4.7%) were diagnosed with delirium during hospitalization. In the multivariable logistic regression analysis after covariate adjustment, male sex (odds ratio [OR] 1.60, 95% confidence interval [CI] 1.23, 2.08; P < 0.001), longer duration of hospitalization (OR 1.02, 95% CI 1.01, 1.03; P < 0.001), neuromuscular blockade use (OR 1.50, 95% CI 1.12, 2.01; P = 0.006), benzodiazepine (OR 1.55, 95% CI 1.13, 2.13; P = 0.007) and propofol (OR 1.48, 95% CI 1.01, 2.17; P = 0.046) continuous infusion, and concurrent depression (OR 1.31, 95% CI 1.01, 1.71; P = 0.044) were associated with a higher prevalence of delirium among ARDS survivors. In the multivariable Cox regression analysis after adjustment for covariates, the occurrence of delirium was not significantly associated with 1-year all-cause mortality, when compared to the other survivors who did not develop delirium (hazard ratio: 0.85, 95% CI 1.01, 1.71; P = 0.044). Conclusions In South Korea, 4.7% of ARDS survivors were diagnosed with delirium during hospitalization in South Korea. Some factors were potential risk factors for the development of delirium, but the occurrence of delirium might not affect 1-year all-cause mortality among ARDS survivors.This research did not receive any specifc grant from funding agencies in the public, commercial, or not-for-proft sectors

Impact of Socioeconomic Status on 30-Day and 1-Year Mortalities after Intensive Care Unit Admission in South Korea: A Retrospective Cohort Study

Background Socioeconomic status (SES) is closely associated with health outcomes, including mortality in critically ill patients admitted to intensive care unit (ICU). However, research regarding this issue is lacking, especially in countries where the National Health Insurance System is mainly responsible for health care. This study aimed to investigate how the SES of ICU patients in South Korea is associated with mortality. Methods This was a retrospective observational study of adult patients aged ≥20 years admitted to ICU. Associations between SES-related factors recorded at the time of ICU admission and 30-day and 1-year mortalities were analyzed using univariable and multivariable Cox regression analyses. Results A total of 6,008 patients were included. Of these, 394 (6.6%) died within 30 days of ICU admission, and 1,125 (18.7%) died within 1 year. Multivariable Cox regression analysis found no significant associations between 30-day mortality after ICU admission and SES factors (P>0.05). However, occupation was significantly associated with 1-year mortality after ICU admission. Conclusions Our study shows that 30-day mortality after ICU admission is not associated with SES in the National Health Insurance coverage setting. However, occupation was associated with 1-year mortality after ICU admission

Comparison of the effects of sugammadex and neostigmine on hospital stayin robot-assisted laparoscopic prostatectomy: a retrospective study

Abstract Background Sugammadex reduces postoperative complications. We sought to determine whether it could reduce the length of hospital stay, post-anesthetic recovery time, unplanned readmission, and charges for patients who underwent robot-assisted laparoscopic prostatectomy (RALP) when compared to neostigmine. Methods This was a retrospective observational study of patients who underwent RALP between July 2012 and July 2017, in whom rocuronium was used as a neuromuscular blocker. The primary outcome was the length of hospital stay after surgery in patients who underwent reversal with sugammadex when compared to those who underwent reversal with neostigmine. The secondary outcomes were post-anesthetic recovery time, hospital charges, and unplanned readmission within 30 days after RALP. Results In total, 1430 patients were enrolled. Using a generalized linear model in a propensity score-matched cohort, sugammadex use was associated with a 6% decrease in the length of hospital stay (mean: sugammadex 7.7 days vs. neostigmine 8.2 days; odds ratio [OR] 0.94, 95% confidence interval [CI] [0.89, 0.98], P = 0.008) and an 8% decrease in post-anesthetic recovery time (mean: sugammadex 36.7 min vs. neostigmine 40.2 min; OR 0.92, 95% CI [0.90, 0.94], P < 0.001) as compared to neostigmine use; however, it did not reduce the 30-day unplanned readmission rate (P = 0.288). The anesthesia charges were higher in the sugammadex group than in the neostigmine group (P < 0.001); however, there were no significant differences between the groups in terms of postoperative net charges (P = 0.061) and total charges (P = 0.100). Conclusions Compared to the reversal of rocuronium effects with neostigmine, reversal with sugammadex after RALP was associated with a shorter hospital stay and post-anesthetic recovery time, and was not associated with 30-day unplanned readmission rates and net charges

A low risk of nosocomial transmission of subclinical tuberculosis to neonates in a postpartum care center under COVID-19 control measures

We report the results of investigating and managing a tuberculosis (TB) exposure in a postpartum care center. Among the contacts exposed to a nursing assistant with subclinical TB, 5 of 44 neonates (11.4%) had positive tuberculin skin tests (TSTs) at 3 months of age, and all the TST-positive neonates received the Bacille Calmette-Guérin vaccination. Seven of 28 healthcare workers (25.0%) and 1 of 3 household contacts (33.3%) were positive in the initial or repeated interferon-gamma release assay. None of the contacts developed TB disease during the study period. Annual TB examinations of healthcare personnel at a postpartum care center under the Tuberculosis Prevention Act in South Korea enabled the early detection of subclinical TB, which reduced the risk of transmission to neonates under strict coronavirus disease 2019 prevention measures

Ultrasound-guided esophageal compression during mask ventilation in small children: a prospective observational study

Background : The use of cricoid compression to prevent insufflation remains controversial, and its use in children is limited. This study aimed to examine the effect of real-time ultrasound-guided esophageal compression on the prevention of gastric insufflation. Method : This prospective observational study was conducted with fifty children aged < 2 years undergoing general anesthesia. Patients were excluded if they were at an increased risk for gastric regurgitation or pulmonary aspiration. Following anesthetic induction under spontaneous breathing, ultrasound-guided esophageal compression was performed during pressure-controlled face-mask ventilation using a gradual increase in peak inspiratory pressure from 10 to 24 cm H2O to determine the pressure at which gastric insufflation occurred. The primary outcome was the incidence of gastric insufflation during anesthetic induction with variable peak inspiratory pressure after real-time ultrasound-guided esophageal compression was applied. Results : Data from a total of 42 patients were analyzed. Gastric insufflation was observed in 2 (4.7%) patients. All patients except one had their esophagus on the left side of the trachea. Applying ultrasound-guided esophageal compression did not affect the percentage of glottic opening scores (P = 0.220). Conclusions : The use of real-time ultrasound-guided esophageal compression pressure can aid preventing gastric insufflation during face-mask ventilation in children less than 2 years old. Trial registration : Clinicaltrials.gov identifier: NCT04645043.This work was supported by the Korea Medical Device Development Fund grant funded by the Korea government (the Ministry of Science and ICT, the Ministry of Trade, Industry and Energy, the Ministry of Health & Welfare, the Ministry of Food and Drug Safety) (Project Number: 202011B23)

Nanovesicles derived from iron oxide nanoparticles-incorporated mesenchymal stem cells for cardiac repair

Because of poor engraftment and safety concerns regarding mesenchymal stem cell (MSC) therapy, MSC-derived exosomes have emerged as an alternative cell-free therapy for myocardial infarction (MI). However, the diffusion of exosomes out of the infarcted heart following injection and the low productivity limit the potential of clinical applications. Here, we developed exosome-mimetic extracellular nanovesicles (NVs) derived from iron oxide nanoparticles (IONPs)-incorporated MSCs (IONP-MSCs). The retention of injected IONP-MSC-derived NVs (IONP-NVs) within the infarcted heart was markedly augmented by magnetic guidance. Furthermore, IONPs significantly increased the levels of therapeutic molecules in IONP-MSCs and IONP-NVs, which can reduce the concern of low exosome productivity. The injection of IONP-NVs into the infarcted heart and magnetic guidance induced an early shift from the inflammation phase to the reparative phase, reduced apoptosis and fibrosis, and enhanced angiogenesis and cardiac function recovery. This approach can enhance the therapeutic potency of an MSC-derived NV therapy.