[Suicide re-attempt risk evaluation scale: a trial in a critical care center without an exclusive duty psychiatrist].

There is a general consensus that patients who attempt suicide require intervention for psychological as well as physical problems. However, among the institutions accepting patients who attempt suicide, there are few institutions employing a full-time psychiatrist in the emergency department. Therefore, it is difficult to conduct a suicide re-attempt risk evaluation in the presence of a psychiatric specialist. We developed a suicide re-attempt risk evaluation scale to be used by non-professional staff. We asked the medical staff that cared for patients who had attempted suicide to record all the evaluation items in the patient's medical record. We utilized an interview method and highlighted the types of answers that needed special attention. When there were two or more answers that needed special attention, we defined the patient as high risk. The number of days of hospitalization did not change as a result of the use of the suicide re-attempt risk estimate scale; however, the quantity of medical records addressing suicide intention and the rate of psychiatric intervention significantly increased. It is unclear whether this score directly led to the prevention of repeat suicide attempts. However, it is notable that use of the scale has led to a change in the behavior of medical staff by mandating a fixed-format risk evaluation.

Effects of expiratory rib-cage compression on oxygenation, ventilation, and airway-secretion removal in patients receiving mechanical ventilation.

BACKGROUND: Expiratory rib-cage compression, a chest physiotherapy technique, is well known as the "squeezing" technique in Japan. OBJECTIVE: To determine the effects of rib-cage compression on airway-secretion removal, oxygenation, and ventilation in patients receiving mechanical ventilation. SETTING: An intensive care unit of an emergency and critical care center at a tertiary-care teaching hospital in Tokyo, Japan. METHODS: Thirty-one intubated, mechanically ventilated patients in an intensive care unit were studied in a randomized, crossover trial. The patients received endotracheal suctioning with or without rib-cage compression, with a minimum 3-hour interval between the 2 interventions. Rib-cage compression was performed for 5 min before endotracheal suctioning. Arterial blood gas and respiratory mechanics were measured 5 min before endotracheal suctioning (baseline) and 25 min after suctioning. The 2 measurement periods were carried out on the same day. RESULTS: There were no significant differences in the ratio of arterial partial pressure of oxygen to fraction of inspired oxygen, P(aCO2), or dynamic compliance of the respiratory system between the 2 periods (before and after endotracheal suctioning). Moreover, there were no significant differences in airway-secretion removal between the 2 periods. CONCLUSIONS: This study suggests that rib-cage compression prior to endotracheal suctioning does not improve airway-secretion removal, oxygenation, or ventilation after endotracheal suctioning in this unselected population of mechanically ventilated patients.