<b>Five Cases of Acute Ventilation Attack Successfully Treated with Shigyakusan in the Emergency Department</b> / 日本東洋医学雑誌

We report five cases of acute hyperventilation attack, with bilateral fullness of the chest and hypochondrium, and bilateral rectus abdominis muscle strain, that were successfully treated with shigyakusan. Case 1 was a 47-year-old female ; case 2 was an 18-year-old female ; case 3 was a 23-year-old female ; case 4 was a 39-year-old male ; and case 5 was a 40-year-old male. All five patients visited the emergency department with complaints of severe dyspnea and tetany. Their abdominal signs were characteristic, with remarkable bilateral fullness of the chest and hypochondrium and bilateral rectus abdominis muscle strain. In cases 1 to 4, the patients were given 2.5 g of shigyakusan extract, and their symptoms promptly improved. In case 5, as the patient could not swallow the prescribed medication at presentation, intramuscular diazepam was given. Thereafter, he complained of continuous severe numbness ; we subsequently gave him shigyakusan, and his numbness promptly improved. In conclusion, shigyakusan seems to be a useful Kampo drug for the treatment of acute hyperventilation attack.

The Association of Fever with Total Mechanical Ventilation Time in Critically Ill Patients

This research aims to investigate the impact of fever on total mechanical ventilation time (TVT) in critically ill patients. Subgroup analysis was conducted using a previous prospective, multicenter observational study. We included mechanically ventilated patients for more than 24 hours from 10 Korean and 15 Japanese intensive care units (ICU), and recorded maximal body temperature under the support of mechanical ventilation (MAX(MV)). To assess the independent association of MAX(MV) with TVT, we used propensity-matched analysis in a total of 769 survived patients with medical or surgical admission, separately. Together with multiple linear regression analysis to evaluate the association between the severity of fever and TVT, the effect of MAX(MV) on ventilator-free days was also observed by quantile regression analysis in all subjects including non-survivors. After propensity score matching, a MAX(MV) ≥ 37.5℃ was significantly associated with longer mean TVT by 5.4 days in medical admission, and by 1.2 days in surgical admission, compared to those with MAX(MV) of 36.5℃ to 37.4℃. In multivariate linear regression analysis, patients with three categories of fever (MAX(MV) of 37.5℃ to 38.4℃, 38.5℃ to 39.4℃, and ≥ 39.5℃) sustained a significantly longer duration of TVT than those with normal range of MAX(MV) in both categories of ICU admission. A significant association between MAX(MV) and mechanical ventilator-free days was also observed in all enrolled subjects. Fever may be a detrimental factor to prolong TVT in mechanically ventilated patients. These findings suggest that fever in mechanically ventilated patients might be associated with worse mechanical ventilation outcome.