The revised post-Cardiac Arrest Syndrome for Therapeutic hypothermia (rCAST) score was proposed to predict neurologic outcomes and mortality among out-of-hospital cardiac arrest (OHCA) patients. However, it has rarely been validated outside Japan. Therefore, this study aimed to investigate this issue. All adult patients admitted to our medical intensive care unit for targeted temperature management (TTM) between July 2015 and July 2021 were enrolled. Their medical records were retrieved, and rCAST scores were calculated. A total of 108 post-cardiac arrest syndrome (PCAS) patients who received TTM were analyzed. According to the rCAST score, 49.1%, 50.0%, and 0.9% of the patients were classified as low, moderate, and high severity, respectively. The areas under the curves for the rCAST score were 0.806 (95% confidence interval [CI]: 0.719–0.876) and 0.794 (95% CI: 0.706–0.866) to predict poor neurologic outcomes and mortality at day 28, respectively. In contrast to the original report, only low-severity patients had favorable neurologic outcomes. The rCAST score showed moderate accuracy in our OHCA patients with PCAS who received TTM to predict poor neurologic outcomes and mortality at day 28.

Background: Polymyxin B hemoperfusion (PMX-HP) is increasingly used as an adjunctive therapy for severe sepsis and septic shock, yet the prognostic significance of continuous renal replacement therapy (CRRT) and vasoactive-inotropic score (VIS) dynamics under real-world ICU practice remains unclear. This study aimed to evaluate whether CRRT requirement and hemodynamic responses to PMX-HP influence short-term mortality among critically ill patients. Methods: We conducted a retrospective cohort study of 64 ICU patients in Taiwan with severe sepsis or septic shock who received PMX-HP. Clinical characteristics, illness severity, VIS measurements before and after PMX-HP, organ-support therapies, and outcomes—including 28-day mortality, ICU and hospital mortality, and lengths of stay—were analyzed. Patients were stratified by CRRT use, and multivariate logistic regression was performed to identify independent predictors of 28-day mortality. Results: Among 64 patients (mean age 66 years; 67% male), 67.2% received CRRT and the overall 28-day mortality was 46.9%. CRRT users exhibited higher crude mortality and higher APACHE II scores. Survivors were younger and had lower baseline severity. Hemodynamic trajectories differed substantially: VIS increased after PMX-HP more frequently in non-survivors than survivors. In multivariate analysis, post-PMX-HP VIS elevation and higher APACHE II were independent predictors of 28-day mortality, whereas CRRT requirement was not an independent determinant. Conclusions: In this real-world cohort, PMX-HP did not significantly reduce mortality. Illness severity and inadequate vasopressor improvement, rather than CRRT use, primarily determined outcomes. VIS elevation following PMX-HP may serve as an early indicator of poor hemodynamic recovery in septic shock.

The radiological manifestations of the aberrant air surrounding the pleura are varied because of the air outlining the organs in and out of the visceral space. The continuity of the visceral space from the neck, mediastinum to the retroperitoneum is originated from embryological development, which is compatible with the findings through laboratory experiments, cadaveric anatomy, and thoracic computer tomography image. We reviewed the embryo development to understand the anatomy of body cavity, which can determine the radiological findings of pneumomediastinum and pneumothorax.

Targeted temperature management (TTM) is often considered to improve post-cardiac arrest patients’ outcomes. However, the optimal timing to initiate cooling remained uncertain. This retrospective analysis enrolled all non-traumatic post-cardiac arrest adult patients with either out-of-hospital cardiac arrest (OHCA) or in-hospital cardiac arrest (IHCA) who received TTM from July 2015 to July 2021 at our hospital. The values of time delay before TTM and time to target temperature were divided into three periods according to optimal cut-off values identified using receiver operating characteristic curve analysis. A total of 177 patients were enrolled. A shorter time delay before TTM (pre-induction time) was associated with a lower survival chance at 28 days (32.00% vs. 54.00%, p = 0.0279). Patients with a longer cooling induction time (>440 minis) had better neurological outcomes (1.58% vs. 1.05%; p = 0.001) and survival at 28 days (58.06% vs. 29.25%; p = 0.006). After COX regression analysis, the influence of pre-induction time on survival became insignificant, but patients who cooled slowest still had a better chance of survival at 28 days. In conclusion, a shorter delay before TTM was not associated with better clinical outcomes. However, patients who took longer to reach the target temperature had better hospital survival and neurological outcomes than those who were cooled more rapidly. A further prospective study was warranted to evaluate the appropriate time window of TTM.