Takuya Takashima, Momoyo Azuma, M Sato, 森脇 好乃美, Saki Saijo, Natsuki Bando, Hiroki Sato, Yuki Nakano, Toshiyuki Nunomura, Manabu Ishihara, Yoshitoyo Ueno, Taiga Itagaki and Jun Oto : Successful treatment of Trichosporon asahii fungemia with isavuconazole in a patient with prominent renal dysfunction and intestinal absorption disorder., Kansenshōgaku Zasshi, 99, 5, 352-356, 2025.
2.
Takuya Takashima, Marina Okubo, Shotaro Otani, Masaki Terazawa, Konomi Moriwaki, Saki Saijo, Natsuki Bando, Kazuki Momota, Hiroki Sato, Yuki Nakano, Toshiyuki Nunomura, Manabu Ishihara, Yoshitoyo Ueno, Taiga Itagaki and Jun Oto : Effect of positive-pressure ventilation before extubation on respiratory function: physiological evaluation under simulated extubation, The Journal of Medical Investigation : JMI, 72, 3, 361-366, 2025.
(Summary)
Positive-pressure ventilation (PPV) before extubation may improve oxygenation and reduce complications after extubation. However, no study has quantitatively evaluated the effects of extubation on breathing and lung volume. A crossover randomized study was performed on 16 patients who received mechanical ventilation and planned to undergo extubation in the intensive-care unit. We used the automatic tube compensation (ATC) mode to simulate extubation. We used electrical impedance tomography and an esophageal balloon catheter to evaluate the work of breathing and lung volume after simulated extubation. We compared the work of breathing and lung volume with and without PPV before simulated extubation. There were no differences in the changes in end-expiratory lung impedance (-7.4 [-18.2-2.3] vs. -11.2 [-16.6-1.1] arbitrary units, p=0.53), anterior-to-posterior ventilation ratio (0.60 [0.49-0.74] vs. 0.60 [0.52-0.79], p=0.75), esophageal pressure swing (4.9 [2.1-8.7] vs. 5.4 [1.9-6.6] cmH2O, p=0.61), dynamic transpulmonary pressure (7.2 [6.7-9.9] vs. 7.6 [6.6-9.7] cmH2O, p=0.93), and pressure time product (2.4 [1.4-4.2] vs. 3.1 [1.0-4.3] cmH2O*s, p=0.84) with and without PPV before simulated extubation. PPV before extubation did not affect breathing work or lung volume after extubation. Therefore, it may delay extubation and increase patient stress. J. Med. Invest. 72 : 361-366, August, 2025.
(Keyword)
electrical impedance tomography / extubation / intensive care unit / spontaneous breathing test / transpulmonary pressure
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, 70, 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.
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腫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, 2022;78, 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.
Taiga Itagaki, Yusuke Akimoto, Yuki Nakano, Yoshitoyo Ueno, Manabu Ishihara, Natsuki Tane, Yumiko Tsunano and Jun Oto : Relationships between double cycling and inspiratory effort with diaphragm thickness during the early phase of mechanical ventilation: A prospective observational study., PLoS ONE, 17, 8, 2022.
(Summary)
Double cycling on the third day of mechanical ventilation was associated with strong inspiratory efforts and, possibly, changes in diaphragm thickness.
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, 69, 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.
Yuki Nakano, Saki Saijo, Natsuki Bando, Hiroki Sato, Kazuki Momota, Takuya Takashima, Toshiyuki Nunomura, Yoshitoyo Ueno, Manabu Ishihara, Taiga Itagaki and Jun Oto : オルニチントランスカルバミラーゼ欠損症による難治性高アンモニア血症に対し集学的治療で神経学的後遺症なく救命できた小児症例．, 第52回日本救急医学会総会・学術集会(10月13∼15日，仙台市), Oct. 2024.
2.
Manabu Ishihara, Saki Saijo, Natsuki Bando, Kazuki Momota, Hiroki Sato, Yuki Nakano, Takuya Takashima, Toshiyuki Nunomura, Yoshitoyo Ueno, Taiga Itagaki and Jun Oto : くも膜下出血治療の現状と課題:救急科・脳神経外科のダブルボード専門医が行う神経集中治療．, 第52回日本救急医学会総会・学術集会(10月13∼15日，仙台市), Oct. 2024.
3.
Takuya Takashima, Momoyo Azuma, Saki Saijo, Natsuki Bando, Yuki Nakano, Toshiyuki Nunomura, Manabu Ishihara, Yoshitoyo Ueno, Taiga Itagaki and Jun Oto : 腎機能障害を有する深在性トリコスポロン症患者に対するイサブコナゾールでの治療経験．, 日本集中治療医学会第8回中国・四国支部学術集会(6月15∼16日，広島市), Jun. 2024.
4.
Manabu Ishihara, Natsuki Bando, Yoshitoyo Ueno, Saki Saijo, Yuki Nakano, Takuya Takashima, Taiga Itagaki and Jun Oto : ドラッグチャレンジテストが診断に有用であった遷延性意識障害の1例．, 日本集中治療医学会第8回中国・四国支部学術集会(6月15∼16日，広島市), Jun. 2024.
5.
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.
6.
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.
7.
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.