Tokushima University / Educator and Researcher Directory --- Nunomura, Toshiyuki

Field of Study

Subject of Study

Book / Paper

Academic Paper (Judged Full Paper):

1.	Hiroki Sato, Emiko Nakataki, Toshiyuki Nunomura, 村上尚哉, 堀洋二, Jun Oto and Taiga Itagaki : 歯性感染症を契機に発症したPrevotella属によるレミエール症候群の一例．, 第51回日本救急医学会総会・学術集会, 2023.
2.	Yuki Nakano, Yoshitoyo Ueno, Emi Ishitani, Koji Sato, Hiroki Sato, Kazuki Momota, Natsuki Bando, Yusuke Akimoto, Toshiyuki Nunomura, Manabu Ishihara, Natsuki Tane, Taiga Itagaki, Yoshiaki Kitamura and Jun Oto : Repetitive postoperative extubation failure due to dynamic inspiratory airway collapse concomitant with subglottic stenosis in a patient who previously underwent tracheostomy., The Journal of Medical Investigation : JMI, Vol.70, No.1.2, 301-305, 2023. (Summary) We should be aware of the history of tracheostomy, especially at high tracheostomy sites, even in the absence of respiratory symptoms as risk factors for dynamic inspiratory airway collapse concomitant with subglottic stenosis contributing to repeated respiratory failure after extubation. J. Med. Invest. 70 : 301-305, February, 2023. (Keyword) Humans / female / Adult / Tracheostomy / Airway Extubation / Constriction, Pathologic / Intubation, Intratracheal / Respiration, Artificial (Tokushima University Institutional Repository) ● Metadata: 118365 (Link to Publication Site) ● Publication site (DOI): 10.2152/jmi.70.301 (Link to Search Site for Scientific Articles) ● PubMed @ National Institutes of Health, US National Library of Medicine (PMID): 37164740 ● Summary page in Scopus @ Elsevier: 2-s2.0-85158867166 (Tokushima University Institutional Repository: 118365, DOI: 10.2152/jmi.70.301, PubMed: 37164740, Elsevier: Scopus)
3.	Yuki Nakano, Koji Sato, Hiroki Sato, Kazuki Momota, Yusuke Akimoto, Toshiyuki Nunomura, Yuta Arai, Manabu Ishihara, Yoshitoyo Ueno, Natsuki Tane, Taiga Itagaki and Jun Oto : 経肺圧を指標としたPEEP設定により，致死的低酸素血症から改善した神経芽細胞種に伴う腹部コンパートメント症候群の一乳児症例, Shikoku Acta Medica, Vol.2022;78, No.3,4, 115-120, 2022. (Summary) Background : Neuroblastoma is the most common extracranial solid tumor of childhood. Although the prognosis of neuroblastoma is relatively good, newborns less than two months of age with stage 4S neuroblastoma may present with aggressive hypoxia and restrictive respiratory impairment due to abdominal compartment syndrome. Case presentation : Two-month-old girl, height of 63 cm and body weight of 10 kg. She was diagnosed as neuroblastoma with Stage 4S. Because she was suffered from refractory hypoxemia and restrictive respiratory impairment due to abdominal compartment syndrome induced by multiple liver metastasis and massive ascites, she was transferred to our ICU. Her trachea was intubated and ventilated with assist/controlled mode, driving pressure 22 cmH2O, positive end-expiratory pressure(PEEP)8 cmH2O, fraction of inspiratory oxygen(FIO2)1.0, but tidal volume was obtained only 3.2 mL/kg and PaO2/FIO2 ratio of 55 mmHg. Therefore, we insert esophageal sensor and monitored esophageal pressure to performed transpulmonary pressure guided PEEP titration. When we changed PEEP from 8 to 15 cmH2O so that the end-expiratory transpulmonary pressure achieving 0 to 5 cmH2O, her oxygenation(PaO2/FIO2 ratio : 55 to 178 mmHg)and respiratory compliance(1.4 to 3.0 mL/cmH2O)were dramatically improved. Her respiratory condition was further stabilized by ascites puncture and radiotherapy, and the patient was extubated successfully on the 25th ICU day. Conclusions : Although pediatric neuroblastoma with stage 4S may induce severe respiratory efficiency, the responsiveness of treatment for neuroblastoma is promising. Multimodal treatments including optimal ventilator management such as transpulmonary pressure -guided PEEP titration contributes to improved patient's prognosis. (Keyword) Neuroblastoma / Abdominal compartment syndrome / Transpulmonary pressure (Link to Search Site for Scientific Articles) ● CiNii @ National Institute of Informatics (CRID): 1520012711615345664 (CiNii: 1520012711615345664)
4.	Yoshitoyo Ueno, Saki Harada, Koji Sato, Kazuki Momota, Hiroki Sato, Yusuke Akimoto, Yuta Arai, Toshiyuki Nunomura, Manabu Ishihara, Natsuki Tane, Taiga Itagaki, Yasuhiko Nishioka and Jun Oto : Independent lung ventilation for the management of acute allograft rejection after single-lung transplantation for end-stage emphysema., The Journal of Medical Investigation : JMI, Vol.69, No.3.4, 323-327, 2022. (Summary) Background : We herein report the use of independent lung ventilation (ILV) for managing acute allograft rejection after single-lung transplantation (SLT) for end-stage emphysema. Case presentation : A 54-year-old woman was transferred to our hospital with severe hypoxemia and respiratory distress due to unilateral lung disease with diffuse alveolar damage in the right donor lung associated with acute allograft rejection and with hyperinflation of the left native lung due to emphysema. She was unresponsive to immunosuppressive medications and conventional ventilation strategies, so different ventilator settings for each lung were required. A double-lumen endotracheal tube (DLT) was inserted, and ILV was initiated. The right lung was ventilated with high positive end-expiratory pressure (PEEP), intended for lung recruitment, and the left lung was ventilated with lung protective strategies using a low tidal volume and low levels of PEEP to avoid hyperinflation. Two days later, her lung function was dramatically improved, and the DLT was replaced with a single-lumen endotracheal tube. Gas exchange was maintained, and she was successfully weaned from mechanical ventilation on intensive-care unit day 15. Conclusions : ILV appears to be effective and safe for managing acute allograft rejection after SLT for emphysema. J. Med. Invest. 69 : 323-327, August, 2022. (Keyword) Allografts / Emphysema / Female / Humans / Lung / Lung Transplantation / Middle Aged / Pulmonary Emphysema / Respiration, Artificial (Link to Publication Site) ● Publication site (DOI): 10.2152/jmi.69.323 (Link to Search Site for Scientific Articles) ● PubMed @ National Institutes of Health, US National Library of Medicine (PMID): 36244790 ● Search Scopus @ Elsevier (PMID): 36244790 ● Search Scopus @ Elsevier (DOI): 10.2152/jmi.69.323 (DOI: 10.2152/jmi.69.323, PubMed: 36244790)
5.	Yusuke Akimoto, Natsuki Bando, Hiroki Sato, Koji Sato, Kazuki Momota, Toshiyuki Nunomura, Yoshitoyo Ueno, Manabu Ishihara, Natsuki Tane, Taiga Itagaki and Jun Oto : Acquired laryngomalacia as a cause of post-extubation respiratory failure in patient with postoperative seizure and central pontine myelinolysis after craniotomy., The Journal of Medical Investigation : JMI, Vol.69, No.3.4, 316-319, 2022. (Summary) Background : Laryngomalacia is a congenital abnormality of the larynx that commonly occurs in children and rarely in adults. We report the first case of acquired laryngomalacia mainly due to postoperative seizure and central pontine myelinolysis after scheduled craniotomy. Case presentation : A 69-year-old man was admitted to the hospital for elective craniotomy for craniopharyngioma. After the surgery, he developed refractory seizure and required intubation and mechanical ventilation in the intensive-care unit (ICU). After treatment for the seizure, he was extubated. However, immediately after extubation, he developed stridor and respiratory retraction. We performed fiberoptic laryngoscopy and confirmed that the epiglottis had collapsed into the posterior wall of the pharynx during inspiration, which was suspected to be laryngomalacia. He received invasive mechanical ventilation for two days following re-extubation. After the second extubation, he developed stridor again due to acquired laryngomalacia. Six days later, his respiratory condition had worsened, and he received re-intubation and tracheostomy. After ICU discharge, central pontine myelinolysis was diagnosed by magnetic resonance imaging. Conclusions : Adult-onset laryngomalacia is a rare cause of upper airway obstruction but should be considered as a cause of postoperative extubation failure. We should not delay performing fiberoptic laryngoscopy to evaluate this pathology and provide optimal treatment. J. Med. Invest. 69 : 316-319, August, 2022. (Keyword) Aged / Airway Extubation / Child / Craniotomy / Humans / Laryngomalacia / Laryngoscopy / Male / Myelinolysis, Central Pontine / Respiratory Insufficiency / Respiratory Sounds / Seizures (Link to Publication Site) ● Publication site (DOI): 10.2152/jmi.69.316 (Link to Search Site for Scientific Articles) ● PubMed @ National Institutes of Health, US National Library of Medicine (PMID): 36244788 ● CiNii @ National Institute of Informatics (CRID): 1390856738295204480 ● Search Scopus @ Elsevier (PMID): 36244788 ● Search Scopus @ Elsevier (DOI): 10.2152/jmi.69.316 (DOI: 10.2152/jmi.69.316, PubMed: 36244788, CiNii: 1390856738295204480)
6.	Yoshitoyo Ueno, Koji Sato, Kazuki Momota, Hiroki Sato, Yuki Nakano, Yusuke Akimoto, Toshiyuki Nunomura, Natsuki Tane, Taiga Itagaki and Jun Oto : The quality and quantity of sleep on dexmedetomidine during high-flow nasal cannula oxygen therapy in critically ill patients., The Journal of Medical Investigation : JMI, Vol.69, No.3.4, 266-272, 2022. (Summary) Purpose : High-flow nasal cannula oxygen therapy (HFNC) is a new type of non-invasive respiratory support for acute respiratory failure patients. However, patients receiving HFNC often develop sleep disturbances. We therefore examined whether dexmedetomidine could preserve the sleep characteristics in patients who underwent HFNC. Patients and Methods : This was a pilot, randomized controlled study. We assigned critically ill patients treated with HFNC to receive dexmedetomidine (0.2 to 0.7 µg / kg / h, DEX group) or not (non-DEX group) at night (9:00 p.m. to 6:00 a.m.). Polysomnograms were monitored during the study period. The primary outcomes were total sleep time (TST), sleep efficiency and duration of stage 2 non-rapid eye movement (stage N2) sleep. Results : Of the 28 patients who underwent randomization, 24 were included in the final analysis (12 patients per group). Dexmedetomidine increased the TST (369 min vs. 119 min, p = 0.024) and sleep efficiency (68% vs. 22%, P = 0.024). The duration of stage N2 was increased in the DEX group compared with the non-DEX group, but this finding did not reach statistical significance. The incidences of respiratory depression and hemodynamic instability were similar between the two groups. Conclusions : In critically ill patients who underwent HFNC, dexmedetomidine may optimize the sleep quantity without any adverse events. J. Med. Invest. 69 : 266-272, August, 2022. (Keyword) Cannula / Critical Illness / Dexmedetomidine / Humans / Oxygen / Sleep (Link to Publication Site) ● Publication site (DOI): 10.2152/jmi.69.266 (Link to Search Site for Scientific Articles) ● PubMed @ National Institutes of Health, US National Library of Medicine (PMID): 36244779 ● CiNii @ National Institute of Informatics (CRID): 1390293788341782528 ● Search Scopus @ Elsevier (PMID): 36244779 ● Search Scopus @ Elsevier (DOI): 10.2152/jmi.69.266 (DOI: 10.2152/jmi.69.266, PubMed: 36244779, CiNii: 1390293788341782528)
7.	Taiga Itagaki, Nobuto Nakanishi, Takuya Takashima, Yoshitoyo Ueno, Natsuki Tane, Yumiko Tsunano, Toshiyuki Nunomura and Jun Oto : Effect of controlled ventilation during assist-control ventilation on diaphragm thickness : a post hoc analysis of an observational study., The Journal of Medical Investigation : JMI, Vol.67, No.3.4, 332-337, 2020. (Summary) Background : Since diaphragm passivity induces oxidative stress that leads to rapid atrophy of diaphragm, we investigated the effect of controlled ventilation on diaphragm thickness during assist-control ventilation (ACV). Methods : Previously, we measured end-expiratory diaphragm thickness (Tdiee) of patients mechanically ventilated for more than 48 hours on days 1, 3, 5 and 7 after the start of ventilation. We retrospectively investigated the proportion of controlled ventilation during the initial 48-hour ACV (CV48%). Patients were classified according to CV48% : Low group, less than 25% ; High group, higher than 25%. Results : Of 56 patients under pressure-control ACV, Tdiee increased more than 10% in 6 patients (11%), unchanged in 8 patients (14%) and decreased more than 10% in 42 patients (75%). During the first week of ventilation, Tdiee decreased in both groups : Low (difference, -7.4% ; 95% confidence interval [CI], -10.1% to -4.6% ; p < 0.001) and High group (difference, -5.2% ; 95% CI, -8.5% to -2.0% ; p = 0.049). Maximum Tdiee variation from baseline did not differ between Low (-15.8% ; interquartile range [IQR], -22.3 to -1.5) and High group (-16.7% ; IQR, -22.6 to -11.1, p = 0.676). Conclusions : During ACV, maximum variation in Tdiee was not associated with proportion of controlled ventilation higher than 25%. J. Med. Invest. 67 : 332-337, August, 2020. (Tokushima University Institutional Repository) ● Metadata: 115438 (Link to Publication Site) ● Publication site (DOI): 10.2152/jmi.67.332 (Link to Search Site for Scientific Articles) ● PubMed @ National Institutes of Health, US National Library of Medicine (PMID): 33148911 ● Summary page in Scopus @ Elsevier: 2-s2.0-85095587008 (Tokushima University Institutional Repository: 115438, DOI: 10.2152/jmi.67.332, PubMed: 33148911, Elsevier: Scopus)

Proceeding of Domestic Conference:

1.	Toshiyuki Nunomura : 布村俊幸．シンポジスト「シンポジウム:DIC診療における疑問点」, 第3回南四国・集中治療医学シンポジウム, Nov. 2023.
2.	Emiko Nakataki, Toshiyuki Nunomura, Hiroki Sato, Taiga Itagaki and 松本大資 : Time limited trialが有効であった若年難治性気胸の一例．, 第45回日本呼吸療法医学会学術集会, Aug. 2023.
3.	福島翔太, Emiko Nakataki, Toshiyuki Nunomura, Hiroki Sato, 川人美鈴, 殿谷淳子, 坂東加奈子 and 津川武弘 : 当院独自の早期離床プロトコルが侵襲的人工呼吸管理症例の退院時日常生活動作レベルに及ぼす影響．, 日本集中治療医学会第7回中国・四国支部学術集会, Jul. 2023.
4.	Koji Sato, Yoshitoyo Ueno, Natsuki Bando, Kazuki Momota, Takuya Takashima, Hiroki Sato, Toshiyuki Nunomura, Manabu Ishihara, Taiga Itagaki and Jun Oto : ステロイドパルス療法後にオルニチントランスカルバミラーゼ欠損症による高アンモニア脳症を発症した1例．, 日本集中治療医学会第7回中国・四国支部学術集会, Jul. 2023.
5.	Hiroki Sato, Emiko Nakataki, Toshiyuki Nunomura, 藤本稜, 川下陽一郎, 山村里恵, Taiga Itagaki and Jun Oto : カルバマゼピンによる薬剤性再生不良性貧血と薬疹から不良な転帰を辿った一症例．, 日本集中治療医学会第7回中国・四国支部学術集会, Jul. 2023.
6.	池崎尚子, Emiko Nakataki, 荒川悠祐, Toshiyuki Nunomura, Hiroki Sato and 曽我朋宏 : 食道裂孔ヘルニア嚢内で発生した結腸穿通に対する手術中に気胸を生じた1症例．, 日本集中治療医学会第7回中国・四国支部学術集会, Jul. 2023.
7.	Toshiyuki Nunomura : 児童虐待が疑われた小児搬送症例．, 令和5年度第1回事後検証症例発表会, Jul. 2023.
8.	Natsuki Bando, Kazuki Momota, Koji Sato, Hiroki Sato, Yusuke Akimoto, Toshiyuki Nunomura, Manabu Ishihara, Yoshitoyo Ueno, Natsuki Tane, Taiga Itagaki and Jun Oto : セツキシマブ投与後のインフュージョンリアクションから心停止に至るも後遺症なく救命できた一症例．, 第39回日本救急医学会中国四国地方会, Jul. 2023.
9.	Koji Sato, Yoshitoyo Ueno, Natsuki Bando, Kazuki Momota, Takuya Takashima, Hiroki Sato, Toshiyuki Nunomura, Manabu Ishihara, Natsuki Tane, Taiga Itagaki and Jun Oto : HELLP症候群に伴う急性肝不全，DICに対して血漿交換療法が効果的であった一症例．, 第39回日本救急医学会中国四国地方会, Jul. 2023.
10.	Hiroki Sato, Emiko Nakataki, Toshiyuki Nunomura, 島谷佳光, Taiga Itagaki and Jun Oto : 原因不明の無菌性髄膜炎を契機に痙攣重積状態に進行し不良な転帰を辿った一症例, 第51回日本集中治療医学会学術集会, Mar. 2023.
11.	Natsuki Bando, Koji Sato, Hiroki Sato, Natsuki Bando, Koji Sato, Toshiyuki Nunomura, Yuki Nakano, Takuya Takashima, Manabu Ishihara, Yoshitoyo Ueno, Taiga Itagaki and Jun Oto : 動脈瘤性くも膜下出血へのクラゾセンタン投与により抜管後喉頭浮腫を来した2症例, 第51回日本集中治療医学会学術集会, Mar. 2023.
12.	Yoshitoyo Ueno, 西條早希, 河原良美, Natsuki Bando, Koji Sato, Hiroki Sato, Takuya Takashima, Toshiyuki Nunomura, Manabu Ishihara, Taiga Itagaki and Jun Oto : 自発呼吸トライアル中のHFVIモニタリングに関する検討, 第51回日本集中治療医学会学術集会, Mar. 2023.
13.	福島翔太, 中瀧恵実子, 久次米里衣, Toshiyuki Nunomura, Yuta Arai, 殿谷淳子, 川人美鈴, 坂東加奈子 and 津川武弘 : 当院独自の早期離床プロトコルが侵襲的人工呼吸管理症例の早期離床に及ぼす影響:過去起点コホート研究．, 第50回日本集中治療医学会学術集会, Mar. 2023.
14.	Kazuki Momota, Natsuki Bando, Koji Sato, Hiroki Sato, Yusuke Akimoto, Toshiyuki Nunomura, Yoshitoyo Ueno, Natsuki Tane, Taiga Itagaki and Jun Oto : 非侵襲的陽圧換気中に縦隔気腫を来したCOVID-19肺炎の一症例．, 第50回日本集中治療医学会学術集会, Mar. 2023.
15.	Yuki Nakano, Koji Sato, Hiroki Sato, Kazuki Momota, Yusuke Akimoto, Toshiyuki Nunomura, Yoshitoyo Ueno, Natsuki Tane, Taiga Itagaki and Jun Oto : 気管切開後25年間無症候性に経過した声門下狭窄が気管挿管を機に増悪し，術後抜管困難となった一症例, 第50回日本集中治療医学会学術集会, Mar. 2023.
16.	Yoshitoyo Ueno, Kazuki Momota, Koji Sato, Hiroki Sato, Yusuke Akimoto, Toshiyuki Nunomura, Manabu Ishihara, Natsuki Tane, Taiga Itagaki and Jun Oto : 末期肺気腫に対する片肺移植後の急性拒絶反応に対し，分離肺換気が奏功した一症例, 第50回日本集中治療医学会学術集会, Mar. 2023.
17.	Toshiyuki Nunomura, 中瀧恵実子, Yuta Arai and Taiga Itagaki : COVID-19 に伴う全身性毛細血管漏出症候群により心肺停止に至った一例．, 第50回日本集中治療医学会学術集会, Mar. 2023.
18.	Yoshitoyo Ueno, Hiroki Sato, Kazuki Momota, Koji Sato, Yusuke Akimoto, Toshiyuki Nunomura, Manabu Ishihara, Natsuki Tane, Taiga Itagaki and Jun Oto : 開心術後患者における乳酸値ピークアウトまでの時間と術後経過との関連, 第50回日本集中治療医学会学術集会, Mar. 2023.
19.	Koji Sato, Yoshitoyo Ueno, Hiroki Sato, Kazuki Momota, Yusuke Akimoto, Toshiyuki Nunomura, Manabu Ishihara, Natsuki Tane, Taiga Itagaki and Jun Oto : VA-ECMO, 第50回日本集中治療医学会学術集会, Mar. 2023.
20.	Yuki Nakano, Koji Sato, Hiroki Sato, Kazuki Momota, Yusuke Akimoto, Toshiyuki Nunomura, Yoshitoyo Ueno, Natsuki Tane, Taiga Itagaki and Jun Oto : 高位気管切開既往患者に生じた声門下狭窄および気管軟化症により術後抜管困難となった一症例, 第6回徳島外科学会, Feb. 2023.
21.	Natsuki Bando, 宮本憲哉, Kazuki Momota, Koji Sato, Hiroki Sato, Yusuke Akimoto, Toshiyuki Nunomura, Manabu Ishihara, Yoshitoyo Ueno, Natsuki Tane, Taiga Itagaki and Jun Oto : セツキシマブ投与後のインフュージョンリアクションから心停止に至るも後遺症なく救命できた一症例, 第6回徳島外科学会, Feb. 2023.
22.	Toshiyuki Nunomura : シンポジスト「シンポジウム．DIC の治療意義について」, 第2回南四国・集中治療医学シンポジウム, Nov. 2022.
23.	Kazuki Momota, Natsuki Bando, Koji Sato, Hiroki Sato, Yusuke Akimoto, Toshiyuki Nunomura, Manabu Ishihara, Yoshitoyo Ueno, Natsuki Tane, Taiga Itagaki and Jun Oto : 重篤な循環不全を呈した重症レジオネラ肺炎に対しVA-ECMO導入により救命した1例．, 第50回日本救急医学会総会・学術集会, Oct. 2022.
24.	荒瀬美晴, 大村健史, 井川浩一, Yuta Arai, Toshiyuki Nunomura, Natsuki Tane, 中瀧恵実子, 三村誠二 and Jun Oto : COVID-19患者におけるエアロゾルの発生を最小限に抑える経皮的気管切開術の工夫．, 第49回日本救急医学会総会・学術集会, Nov. 2021.
25.	Toshiyuki Nunomura, Taiga Itagaki, Yuta Arai, 中瀧恵実子 and Jun Oto : 集中治療室内での患者-人工呼吸器非同調に対する意識調査．, 第1回南四国・集中治療医学フォーラム, Nov. 2021.

Designated Assistant Professor : Nunomura, Toshiyuki

Research

Field of Study

Subject of Study

Book / Paper

Academic Paper (Judged Full Paper):

Proceeding of Domestic Conference: