Effect of availability of video laryngoscopy on the use of fiberoptic intubation in school-aged children with microtia.

BACKGROUND: With the increasing popularity of video laryngoscopy during intubation of pediatric patients with normal or difficult airways, fiberoptic-assisted tracheal intubation, traditionally considered the gold standard for difficult intubation, may become underused. AIM: We aimed to assess the use of airway management techniques before and after introduction of video laryngoscopy in a cohort of school-aged children with microtia, who are at increased risk of difficult intubation. METHODS: We retrospectively reviewed intubation devices used for all pediatric patients with microtia who had undergone reconstructive ear surgery at a single institution during the period January 2008 to December 2012. In each case, we identified the original airway management technique and success rate, as well as success rate for subsequent rescue techniques. The use of fiberoptic-assisted tracheal intubation was compared before and after introduction of a pediatric blade for the Pentax-AWS video laryngoscope. RESULTS: This study included 537 consecutive intubation procedures; 264 before and 273 after introduction of the pediatric airway scope. Elective use of fiberoptic-assisted tracheal intubation for anticipated difficult intubation was significantly less after introduction of the pediatric airway scope (before: 19 of 79, 24% vs after: 3 of 79, 4%; odds ratio 8.02; 95% confidence interval, 2.27 to 28.39; P = .0003), which achieved a 100% success rate when used as the primary technique in both routine and difficult airways. All 5 cases of failed direct laryngoscopy were rescued by the pediatric airway scope, thus eliminating emergency use of fiberscopy. CONCLUSION: Introduction of a pediatric video laryngoscope resulted in a substantial decrease in the use of fiberoptic-assisted tracheal intubation. This change in intubation method might not influence the success rate of intubation in experienced hands but could be relevant for novice users.

The Impact of Ventilator-Associated Events in Critically Ill Subjects With Prolonged Mechanical Ventilation.

BACKGROUND: The Centers for Disease Control and Prevention recently released a surveillance definition for respiratory complications in ventilated patients, ventilator-associated events (VAEs), to replace ventilator-associated pneumonia (VAP). VAEs consist of ventilator-associated conditions (VAC), infection-related ventilator-associated complications (IVAC), and possible VAP. A duration of mechanical ventilation of at least 4 d is required to diagnose VAE. However, the observed duration of mechanical ventilation was < 4 d in many previous studies. We evaluated the impact of VAEs on clinical outcomes in critically ill subjects who required mechanical ventilation for ≥ 4 d. METHODS: This single-center retrospective cohort study was conducted in the general ICU of an academic hospital. We included 407 adult subjects who were admitted to the ICU and required mechanical ventilation for at least 4 d. VAC and IVAC were identified from the electronic medical records. VAP was defined according to the Centers for Disease Control and Prevention 2008 criteria and was identified from the surveillance data of the infection control team of our hospital. Clinical outcomes were studied in the VAC, IVAC, and VAP groups. Possible VAP was not investigated. RESULTS: Higher mortality was seen in VAC and IVAC subjects, but not in VAP subjects, compared with those without VAEs and VAP. By multivariable hazard analysis for hospital mortality, IVAC was independently associated with hospital mortality (hazard ratio 2.42, 95% CI 1.39-4.20, P = .002). VAC also tended to show a similar association with hospital mortality (hazard ratio 1.45, 95% CI 0.97-2.18, P = .07). On the other hand, VAP did not increase a hazard of hospital death (hazard ratio 1.08, 95% CI 0.44-2.66, P = .87). CONCLUSIONS: We found that a VAE was related to hospital mortality in critically ill subjects with prolonged mechanical ventilation, and that VAP was not.

QOL models constructed for the community-dwelling elderly with ikigai (purpose in life) as a composition factor, and the effect of habitual exercise.

The purpose of this study was to construct QOL models for the elderly that included ikigai as a composition factor and to clarify differences in two kinds of models, one constructed for the elderly with habitual exercise and the other for those without it. The subjects were 1,566 healthy community-dwelling independent people aged 60 years or more (752 males, 814 females). First, the ratio of subjects with ikigai was calculated. The ratios of subjects with different kinds of objects of ikigai were also calculated. Next, structural equation models (SEM) were constructed on the basis of social, physical, and mental QOL and ikigai. Fits of the models were evaluated. To examine whether the presence or absence of habitual exercise caused any difference in the QOL model, subjects were divided into 4 groups according to whether they were male or female and whether they had or did not have an exercise habit. Multi-population group simultaneous analysis was then performed among the four groups. More than 85% of the subjects had objects of ikigai. Ikigai is an important factor for comprehending the QOL of the elderly. It was possible to construct QOL models for the elderly with ikigai as a composition factor. The effect of physical QOL on mental QOL was negligible in females irrespective of whether they had an exercise habit. The effect of social QOL on mental QOL was profound in aged females with an exercise habit. The effect of the living situation on mental QOL was profound in aged females without an exercise habit. The effect of mental QOL on ikigai was more marked in subjects without an exercise habit than in those with an exercise habit.

Gender difference of subjective symptoms of fatigue among Japanese adolescents.

OBJECTIVES: The purpose of this study was to quantitatively and qualitatively examine a gender difference of subjective symptoms of fatigue (SSF) in healthy students. METHODS: The subjective fatigue scale for young adults (SFS-Y) consisted of the following 6 subscales: concentration thinking difficulty, languor, reduced activation, reduced motivation, drowsiness and feeling of physical disintegration. The SFS-Y was administered to 5,435 students aged 15 to 20 yr. Student's t test was used to examine quantitative gender differences for items and factor scores. The qualitative gender difference was examined by comparing factor structures obtained from confirmatory factor analysis. A similarity in the factor structure was evaluated from: 1) interpreted factor names, 2) factor loadings, 3) degree of fit, and 4) congruence coefficient. RESULTS: A complaint of SSF shows gender differences, but the difference is not remarkable. The factor structure of SSF in males and females is suggested to be the same, because six factors with the same name were interpreted in both groups and the similarity of factor structure was very high. CONCLUSION: There are some qualitative gender differences in SFS, but no qualitative gender differences in factor structure.

[Relationship between chronic fatigue and subjective symptoms of fatigue with performance status (P.S.) and subjective fatigue scale for young adults (SFS-Y)].

OBJECTIVE: Today, fatigue complaints in adolescence are regarded as an issue for young adults as they may progress to the chronic fatigue syndrome. The purpose of this study was to examine the relationships between chronic fatigue based on self-reported performance states (P.S.) and subjective symptoms of fatigue assessed with a fatigue scale for young adults (SFS-Y). METHOD: The SFS-Y consisted of 24 item questions represonting 6 sub-scales, for difficulty in concentrated thinking, languor, reduced activation, reduced motivation, drowsiness and feeling of physical disintegration. The SFS-Y and for assessing fatigue symptoms and P.S. for chronic fatigue were administered to 548 male and female students aged 15-18 yr and to 608 male students aged 16-18 yr, respectively. Discriminant analysis and a logistic analysis model were employed to define the relevance of subjective symptoms of fatigue to chronic fatigue. RESULTS: It was determined that the SFS-Y can discliminate P.S. with high probability (74.0-81.4%), with accuracy beyond a fixed level. In particular, the correlation with "difficulty in concentrated thinking" was high. CONCLUSION: It was judged that the SFS-Y is effective as an index for discrimination of chronic fatigue in young adults with a particularly high relationship between "difficulty in centrated thinking" and chronic fatigue.

The relationship and its change with aging between ADL and daily life satisfaction characteristics in independent Japanese elderly living at home.

The purposes of this study were to examine the characteristics of the relationship between ADL ability and daily life satisfaction and the pattern change with aging in independent Japanese elderly, and to compare these tendencies between males and females. The characteristics of ADL ability and daily life satisfaction of 482 subjects (213 males, 269 females) were investigated in a self-response survey. Seventy-four ADL items, considered from previous studies, were selected from nine ADL domains of 1) movement, 2) going up and down stairs, 3) changing and holding posture, 4) bathing, 5) toileting, 6) dressing, 7) grooming, 8) eating, and 9) manual activities, and nine items of daily life satisfaction were selected from physical, psychological and sociological factors. Both ADL ability and life satisfaction of independent elderly tended to decline with aging. From correlation analysis, since life satisfaction of the elderly was higher with high ADL ability level, it was considered that ADL ability level is one of the important factors in providing for life satisfaction of independent elderly. The subjective symptoms of inconvenience in the lower extremity and lumbar region increased from the 70s in both genders, and the use of assisting devices for movement remarkably increased in the 80s in both genders. The use of assisting devices closely related to the activity area in daily life and influenced the characteristics of life satisfaction and its age-related change in the relationship between ADL ability and life satisfaction. The relationship between ADL ability and satisfaction with physical function was similar in both genders, while the relationship between ADL ability and satisfaction with sociological and psychological factors was different between males and females. Since the relationship between ADL ability and life satisfaction of independent elderly is influenced by a combination of personal, cultural, and environmental factors, additional study must investigate in detail the influence of these factors.

Validity and reliability of body composition assessed by the sulphur hexafluoride dilution method.

The aims of this study were to assess the validity and reliability of body volume and percent body fat determined by sulphur hexafluoride dilution, using underwater weighing as the criterion method, and to determine the influence of the magnitude of body volume. Thirty-one healthy Japanese individuals aged 18-27 years (16 males: height 1.70 +/- 0.06 m, mass 64.8 +/- 7.7 kg; 15 females: height 1.60 +/- 0.05 m, mass 55.2 +/- 6.2 kg; mean +/- s) participated in the study. Sulphur hexafluoride dilution measures the concentration of sulphur hexafluoride gas in the chamber (BSF-200, Shimazu Corp.). Underwater weighing was performed five times using a weight scale (AD-6204, A&D) after residual volume had been determined (System9, Minato Medical Corp.). There were no significant differences in the mean between two trials for body volume, body density or percent body fat determined by sulphur hexafluoride dilution. The intra-class correlation coefficient of these variables ranged from 0.985 to 0.999. The results suggest that sulphur hexafluoride dilution is a reliable method for assessing body composition. There was no significant difference in body volume or percent body fat between sulphur hexafluoride dilution (males: 61.3 +/- 7.6 litres, 18.4 +/- 6.7%; females: 52.8 +/- 6.9 litres, 21.0 +/- 8.9%) and underwater weighing (males: 60.6 +/- 7.0 litres, 15.6 +/- 3.5%; females: 53.0 +/- 6.5 litres, 23.7 +/- 6.1%) and there was a high correlation between the two (r = 0.997, P < 0.05). A Bland-Altman plot of the difference between percent body fat estimated by underwater weighing and sulphur hexafluoride dilution versus average percent body fat by the two methods showed no systematic difference (mean difference = -0.12 +/- 6.6 kg). The upper and lower limits of agreement were 13.2% and -13.4%, respectively. Determination by sulphur hexafluoride dilution resulted in both over- and underestimations in body volume and the difference between the two body volumes (determined by underwater weighing and by sulphur hexafluoride dilution) was inversely proportional to the mean body volume by the two methods. This suggests that improvements need to be made to the device or to the technique to maintain a constant volume of sulphur hexafluoride in the chamber.

The validity and reliability of relative body fat estimates and the construction of new prediction equations for young Japanese adult males.

The aims of this study were to assess the reliability and validity of three methods of bioelectrical impedance analysis (based on induction between the hand and foot, between one foot and the other foot and between one hand and the other hand) and the skinfold method, and to construct prediction equations for total body density by examining cross-validity in young Japanese adult males. The participants were 50 Japanese males aged 18-27 years (height 1.72 +/- 0.06 m, body mass 64.9 +/- 9.0 kg; mean +/- s), each of whom was measured twice using each of the four methods. Relative body fat based on underwater weighing was used as the criterion for validity. To construct prediction equations for body density, we used multiple regression analysis, whereby all possible combinations were examined. The reliability of all three bioelectrical impedance methods was high (R = 0.999). Three new prediction equations were constructed for the hand-foot method, foot-foot method and skinfold method. The cross-validity of the equations was guaranteed. The relative body fat calculated using the new equations did not differ from that based on the underwater weighing method.