TAKAYUKI NISHIGAKI

Introduction: A survey was conducted on the quantity of infusion pumps and syringe pumps owned by medical institutions employing clinical engineers, along with reference indices. <br>Methods: The survey was carried out between April 15 and July 30, 2022. A total of 11 items were surveyed, including pump quantities. Medical institutions were categorized into hospitals and clinics, and the correlation with the number of units owned per bed was examined. Descriptive statistics served as reference indices. <br>Results: The average number of pumps per bed was 0.39 for infusion pumps and 0.27 for syringe pumps, with the pump quantity rising in proportion to the number of beds. The most frequently utilized reference indices for determining the number of owned units were the operating ratio and the maximum number of units in use, in that sequence. However, there was variation in the calculation formula for the operating ratio among medical institutions. <br>Conclusion: The quantity of infusion pumps and syringe pumps owned was ascertained using foundational data, which, for the first time, incorporated indicators beyond the operating ratio.

It currently remains unclear whether stroke volume variation (SVV) before hemodialysis (HD) is an independent predictor of decreased blood pressure (BP) during HD. Fifty-two patients were divided into two groups (Decreased BP during HD group: N = 10, Non-decreased BP group: N = 42). Fractional shortening was lower, and mean arterial pressure (MAP) and SVV were higher in the Decreased BP during HD group. A multiple logistic regression analysis identified low fractional shortening, high MAP, and high SVV as independent predictors of decreased BP during HD. The areas under the ROC curves were as follows: 0.849 for MAP, 0.712 for SVV, and 0.893 for MAP and SVV. Optimal threshold values were 93.0 mm Hg for MAP and 17.3 % for SVV. A multivariate regression analysis identified anemia and a longer dialysis vintage as independently related factors for higher SVV. Our results suggest that high SVV is an independent predictor for decreased BP during HD.

This study aimed to assess the efficacy of a new pediatric extra-corporeal life support (ECLS) system (Endumo 2000, Heiwa Bussan, Tokyo, Japan) for postoperative management after the Norwood operation. Thirty-three consecutive patients with hypoplastic left heart syndrome or its variant undergoing the Norwood operation between August 2007 and December 2013 were divided into two groups according to available ECLS devices. Before November 2009, pediatric Emersave (TERUMO, Saitama, Japan) was employed as the ECLS device, and 14 patients were operated on during this period (Emersave era: 7 boys; 2.9 kg). After December 2009, Endumo 2000 was employed and 19 patients were operated on (Endumo era: 8 boys, 3.1 kg). The demographic characteristics of both groups showed no significant differences. ECLS was initiated in 7 of 14 patients (50%) during the Emersave era and 7 of 19 patients (37%) during the Endumo era (p = 0.45). Chest reentry for hemostasis during ECLS support was more frequently needed in patients supported by Emersave (5/7) than Endumo (1/7) (p = 0.03). The first ECLS circuit durability of Endumo was significantly longer than that of Emersave (p = 0.01). The survival at discharge rate in patients required ECLS was 0% (0/7) when supported by Emersave, but 57% (4/7) by Endumo (p = 0.02). As a result, the survival at discharge rate was 43% (6/14) in the Emersave era and 79% (14/19) in the Endumo era (p = 0.03). Longer durability and superior antithrombogenicity of the Endumo 2000 contributed to the improvement of surgical outcomes after the Norwood operation.

A 5-year-old girl with right atrial isomerism, complete atrioventricular septal defect, hypoplastic left ventricle, double outlet right ventricle, and mixed-type total anomalous pulmonary venous connection with totally occluded left pulmonary veins presented at our center for fenestrated total cavo-pulmonary connection with an extra cardiac conduit at the age of 3 years. Eleven months after the Fontan completion, she developed protein-losing enteropathy (PLE). Spontaneously closed fenestration was thought to be the cause of the PLE, and she underwent revision of fenestration at the age of 5 years. After the operation, PLE did not improve, and newly developed hypoxemia impaired her systemic ventricular function, leading to the initiation of veno-arterial extracorporeal membrane oxygenation (ECMO) with the Endumo(®) system 18 days after the operation to treat her hemodynamic instability. Although the ECMO circuit was changed three times during the first 8 days, the fourth circuit could be used for 74 days without hemolysis and serum leakage, until the patient unfortunately died 82 days after the operation due to multi-organ failure.