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.
(要約)
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.
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.
(要約)
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.
(要約)
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.