Comparison of Two Different Intensive Care Unit Systems for Severely Ill Children in Japan: Data from the JaRPAC Registry.

The importance of centralizing treatment services for severely ill children has been well established, but such entralization remains difficult in Japan. We aimed to compare the trauma and illness severity and mortality of children admitted to two common types of ICUs for children. According to the type of management and disposition of the medical provider, we classified ICUs as pediatric ICUs [PICUs] or general ICUs, and analyzed differences in endogenous and exogenous illness settings between them. Overall, 1,333 pediatric patients were included, with 1,143 patients admitted to PICUs and 190 patients to general ICUs. The Pediatric Cerebral Performance Category score (PCPC) at discharge was significantly lower in the PICU group (adjusted OR: 0.45; 95%CI: 0.23-0.88). Death and unfavorable neurological outcomes occurred less often in the PICU group (adjusted OR: 0.29; 95%CI: 0.14-0.60). However, when limited to exogenous illness, PCPC scores (adjusted OR: 0.38; 95%CI: 0.07-1.99) or death/unfavorable outcomes (adjusted OR: 0.72; 95%CI: 0.08-6.34) did not differ between the groups. PCPC deterioration and overall sequelae/death rates were lower in PICUs for children with endogenous illnesses, although the outcomes of exogenous illness were similar between the 2 unit types. Further studies on the necessity of centralization are warranted.

[A case of pulmonary tuberculosis with multiple pneumatoceles in adult].

We describe a 32-year-old woman suspected of having pulmonary tuberculosis due to abnormal shadows found on her chest x-ray in a community health examination in September 2002. However, she consistently refused further examinations and treatment. In January 2005, she complained of a cough and sputum, by October she developed diarrhea, and by December a sore throat and fever. She was admitted to our hospital on January 23, 2006. Her chest radiograph revealed multiple thin-walled cystic lesions and infiltrative shadows in both upper lobes of the lung, a giant thin-walled cystic lesion in the superior segment of the left lower lobe, and diffuse particulate shadows. Since acid-fast staining of her sputum smear and a PCR test to detect tubercle bacilli both were positive, a diagnosis of pulmonary tuberculosis was made and we treated her with antituberculotic agents. Ten days after starting the treatment, her cystic lesions decreased or disappeared. Although she was seemingly healthy, her pulmonary tuberculosis became more severe since she failed to follow her treatment regimen. She therefore developed nutritional disorders and cellular immunity dysfunction that induced a sequence of changes, e.g. poor granuloma formation, excaration of caseous necrofic material by draining bronchi, and a check-valve mechanism. We speculate that these symptoms caused the formation of pneumatoceles. To our knowledge, this is the first case of pneumatocele formation found in a patient with pulmonary tuberculosis reported in Japan.