急性呼吸不全における横隔膜保護的人工呼吸戦略

急性呼吸不全における横隔膜保護的人工呼吸戦略

Journal of the Japanese Society of Intensive Care Medicine


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

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.


Relationships between double cycling and inspiratory effort with diaphragm thickness during the early phase of mechanical ventilation: A prospective observational study.

Double cycling on the third day of mechanical ventilation was associated with strong inspiratory efforts and, possibly, changes in diaphragm thickness.


Independent lung ventilation for the management of acute allograft rejection after single-lung transplantation for end-stage emphysema.

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.

The Journal of Medical Investigation : JMI


Acquired laryngomalacia as a cause of post-extubation respiratory failure in patient with postoperative seizure and central pontine myelinolysis after craniotomy.

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.


The quality and quantity of sleep on dexmedetomidine during high-flow nasal cannula oxygen therapy in critically ill patients.

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.


人工呼吸器のウィーニングと抜管

人工呼吸器のウィーニングと抜管


集中治療室での早期離床の取り組みにおける基礎知識とアップデート

集中治療室での早期離床の取り組みにおける基礎知識とアップデート


救急・集中治療(33巻3号) ショック管理2021-`22

救急・集中治療(33巻3号) ショック管理2021-`22


Assessment of catabolic state in infants with the use of urinary titin N-fragment.

Urinary titin N-fragment levels have been used to assess the catabolic state, and we used this biomarker to evaluate the catabolic state of infants. We retrospectively measured urinary titin N-fragment levels of urinary samples. The primary outcome was its changes according to postmenstrual age. The secondary outcomes included differences between gestational age, longitudinal change after birth, influence on growth, and relationship with blood tests. This study included 219 patients with 414 measurements. Urinary titin N-fragment exponentially declined with postmenstrual age. These values were 12.5 (7.1-19.6), 8.1 (5.1-13.0), 12.8 (6.0-21.3), 26.4 (16.4-52.0), and 81.9 (63.3-106.4) pmol/mg creatinine in full, late, moderate, very, and extremely preterm infants, respectively (p < 0.01). After birth, urinary levels of titin N-fragment exponentially declined, and the maximum level within a week was associated with the time to return to birth weight in preterm infants ( = 0.39, p < 0.01). This was correlated with creatine kinase in full-term infants ( = 0.58, p < 0.01) and with blood urea nitrogen in preterm infants ( = 0.50, p < 0.01). The catabolic state was increased during the early course of the postmenstrual age and early preterm infants. Catabolic state in infants, especially in preterm infants, was expected to be increased, but no study has clearly verified this. In this retrospective study of 219 patients with 414 urinary titin measurements, the catabolic state was exponentially elevated during the early postmenstrual age. The use of the urinary titin N-fragment clarified catabolic state was prominently increased in very and extremely preterm infants.


歯科麻酔科医に役立つ周術期の呼吸管理

歯科麻酔科医に役立つ周術期の呼吸管理

Journal of Japanese Dental Society of Anesthesiology


Effect of vibration therapy on physical function in critically ill adults (VTICIA trial): protocol for a single-blinded randomised controlled trial.

This study will enrol 188 adult critically ill patients who require further ICU stay after they can achieve sitting at the edge of the bed or wheelchair. The sample size calculation is based on a 15% improvement of Functional Status Score for the ICU. They will be randomised to vibration therapy coupled with protocolised mobilisation or to protocolised mobilisation alone; outcomes will be compared between the two groups. Therapy will be administered using a low-frequency vibration device (5.6-13 Hz) for 15 min/day from when the patient first achieves a sitting position and onward until discharge from the ICU. Outcome assessments will be blinded to the intervention. Primary outcome will be measured using the Functional Status Score for the ICU during discharge. Secondary outcomes will be identified as follows: delirium, Medical Research Council Score, ICU-acquired weakness, the change of biceps brachii and rectus femoris muscle mass measured by ultrasound, ICU mobility scale and ventilator-free and ICU-free days (number of free days during 28 days after admission). For safety assessment, vital signs will be monitored during the intervention.


Elevated Urinary Titin and its Associated Clinical Outcomes after Acute Stroke.

Urinary titin rapidly increased after stroke and was associated with impaired functional outcomes at hospital discharge.

Forty-one patients were included (29 male; age, 68 ± 15 years), 29 had ischemic stroke, 8 had intracerebral hemorrhage, and 4 had subarachnoid hemorrhage. The levels of urinary titin on days 1, 3, 5, and 7 were 9.9 (4.7-21.1), 16.2 (8.6-22.0), 8.9 (4.8-15.2), and 8.7 (3.6-16.2) pmol/mg Cr, respectively. The peak urinary titin level was associated with the mRS score (r = 0.55, p < 0.01), the NIHSS score (r = 0.72, p < 0.01), and the BI (r = -0.59, p < 0.01) upon hospital discharge. In multivariate analysis, the peak urinary titin was associated with poor outcome (p = 0.03).

Journal of Stroke & Cerebrovascular Diseases


Urinary Titin N-Fragment as a Biomarker of Muscle Atrophy, Intensive Care Unit-Acquired Weakness, and Possible Application for Post-Intensive Care Syndrome.

Titin is a giant protein that functions as a molecular spring in sarcomeres. Titin interconnects the contraction of actin-containing thin filaments and myosin-containing thick filaments. Titin breaks down to form urinary titin N-fragments, which are measurable in urine. Urinary titin N-fragment was originally reported to be a useful biomarker in the diagnosis of muscle dystrophy. Recently, the urinary titin N-fragment has been increasingly gaining attention as a novel biomarker of muscle atrophy and intensive care unit-acquired weakness in critically ill patients, in whom titin loss is a possible pathophysiology. Furthermore, several studies have reported that the urinary titin N-fragment also reflected muscle atrophy and weakness in patients with chronic illnesses. It may be used to predict the risk of post-intensive care syndrome or to monitor patients' condition after hospital discharge for better nutritional and rehabilitation management. We provide several tips on the use of this promising biomarker in post-intensive care syndrome.


The effect of high-flow nasal cannula on diaphragm dysfunction including paradoxical diaphragmatic contraction in the intensive care unit.

Background : Diaphragm dysfunction is a serious problem. However, a few management techniques exist for diaphragm dysfunction. Methods : Adult patients treated with high-flow nasal cannula (HFNC) in the intensive care unit were included in this study. The diaphragm function was evaluated using ultrasound measurement of thickening fraction before and after HFNC liberation. Normal diaphragm contraction was defined as thickening fraction ≥ 15% without HFNC, whereas decreased or paradoxical diaphragm contractions were 0%-15% or < 0%, respectively. Results : Forty patients were enrolled, and 16 (40%) had normal diaphragm contraction, whereas 19 (48%) or 5 (13%) had decreased or paradoxical diaphragm contractions, respectively. Thickening fraction increased after HFNC liberation (27.0% ± 25.7% vs. 38.8% ± 34.5%, p = 0.03 in HFNC vs. no HFNC) in patients without diaphragm dysfunction. In patients with decreased diaphragm contraction, thickening fraction did not change with or without HFNC (8.9% ± 11.7% vs. 6.7% ± 5.2%, p = 0.35), whereas paradoxical contraction decreased with HFNC (1.0% ± 10.2% vs. -10.3% ± 2.7%, p = 0.04) in patients with paradoxical diaphragm contraction. Conclusions : The work of breathing decreased with HFNC in patients without diaphragm dysfunction, but did not decrease in patients with decreased diaphragm contraction. Paradoxical diaphragm contraction decreased with HFNC. J. Med. Invest. 68 : 159-164, February, 2021.


術後肺合併症を予防する呼吸管理

術後肺合併症を予防する呼吸管理

The Japanese Journal of Surgical Metabolism and Nutrition


Utilization of crowdfunding in the intensive care field : Muscle atrophy zero project and a questionnaire survey

集中治療領域におけるクラウドファンディングの活用:筋萎縮ゼロプロ ジェクトとアンケート調査

In recent years, it is not easy to secure research funding, and this is a serious problem especially for young researchers. Therefore, we conducted a crowdfunding called Muscle Atrophy Zero Project and received research funding of 2 5 million yen in 2 months. Muscle Atrophy Zero Project aims to do a research about causes, diagnoses, and preventions of muscle atrophy in critically ill patients. In a questionnaire survey conducted by the crowdfunding organization(for all projects), 5% donated due to the attractive return gifts, and about half due to research or project content. We considered Muscle Atrophy Zero Project obtained the understanding for its contribution to the society. Through crowdfunding, we will deepen the understanding in the intensive care field as well as ensuring research funding.


ARDS に対する長期人工呼吸管理中に不動に伴う高 Calcium 血症を呈した 1例

Immobilization hypercalcemia is a rare complication in critically ill patients and causes weakness and gastrointestinal symptoms, symptoms that may lead to delayed rehabilitation and mobilization. A45-year-old woman developed ARDS and received prolonged mechanical ventilation. She received deep sedation to control excessive inspiratory effort and agitation until the 10th day. She developed hypercalcemia, which induced nausea and vomiting, on the fifth day. It was difficult to implement early physical rehabilitation and mobilization due to hypercalcemic symptoms. She was diagnosed with immobilization hypercalcemia and received alendronate sodium and elcatonin. The serum corrected calcium rapidly normalized and nausea disappeared after these drugs administration. After that, she underwent rehabilitation and was liberated from mechanical ventilation on the 63rd day. For the diagnosis of immobilization hypercalcemia, it is important to recognize risk factors such as long-term immobility, obesity, and an internal history of antiestrogens preparation. We should consider pharmacological intervention if it is difficult to implement early rehabilitation and mobilization due to symptoms of hypercalcemia.


呼吸管理のデバイス-加温加湿デバイス-「呼吸管理管理中の加温加湿デバイス:その原理と使用法」

The Japanese Journal of Respiratory Care


Upper limb muscle atrophy associated with in-hospital mortality and physical function impairments in mechanically ventilated critically ill adults: a two-center prospective observational study.

Upper limb muscle atrophy was associated with in-hospital mortality and physical function impairments; thus, it is prudent to monitor it. (321 words) TRIAL REGISTRATION: UMIN 000031316 . Retrospectively registered on 15 February 2018.

In this two-center prospective observational study, we included adult patients who were expected to require mechanical ventilation for > 48 h and remain in the intensive care unit (ICU) for > 5 days. We used ultrasound to evaluate the cross-sectional area of the biceps brachii on days 1, 3, 5, and 7 and upon ICU discharge along with assessment of physical functions. The primary outcome was the relationship between muscle atrophy ratio and in-hospital mortality on each measurement day, which was assessed using multivariate analysis. The secondary outcomes were the relationships between upper limb muscle atrophy and Medical Research Council (MRC) score, handgrip strength, ICU Mobility Scale (IMS) score, and Functional Status Score for the ICU (FSS-ICU).


Effect of Electrical Muscle Stimulation on Upper and Lower Limb Muscles in Critically Ill Patients: A Two-Center Randomized Controlled Trial.

In critically ill patients, electrical muscle stimulation prevented upper and lower limb muscle atrophy and attenuated proteolysis and decreased the length of hospitalization.


Upper limb movements and the risk of unplanned device removal in mechanically ventilated patients.


Early Initiation of Awake Veno-Venous Extracorporeal Membrane Oxygenation Can Attenuate Muscle Atrophy and Weakness in Acute Respiratory Distress Syndrome.

Patients with acute respiratory distress syndrome (ARDS) exhibit prominent muscle atrophy and weakness. Although these patients often require deep sedation to perform lung-protective ventilation, extracorporeal membrane oxygenation (ECMO) can keep patients awake and make mobilization possible. A 60-year-old man was treated with ECMO due to ARDS. A multidisciplinary team conducted mobilization with standing on day 3. During intensive care unit (ICU) stay, catabolism was ongoing (urinary titin: 24.1-38.4 pmol/mg Cr), but the rectus femoris muscle, measured by ultrasound, moderately decreased by 5.3%, 10.8%, and 13.0% on days 3, 5, and 7, respectively, with maintained Medical Research Council score of 58-60. Diaphragm thickness remained unchanged. On day 5, he was separated from ECMO. After ambulation training, he was discharged from ICU on day 7. He returned home without prominent physical dysfunction. Our experience indicates early initiation of awake ECMO can accompany mobilization and attenuate muscle atrophy and weakness in ARDS.


Successful Vancomycin Dose Adjustment in a Sepsis patient with Bacterial Meningitis Using Cystatin C.

Cystatin C-guided vancomycin (VCM) dosing is useful in critically ill patients. Its usefulness in septic patients with bacterial meningitis remains unknown, as there are no published reports. In this study, we sought to clarify its benefit. Cystatin C was used to guide VCM dosing in a septic bacterial meningitis patient with normal kidney function, according to therapeutic drug monitoring (TDM). Using cystatin C, the Bayesian method-based TDM made optimal VCM dosing possible, and decreased the predicted error (4.85 mg/L) compared to serum creatinine (16.83 mg/L). We concluded TDM of VCM using cystatin C can be considered in sepsis patients with bacterial meningitis with normal kidney function.


Effect of High-Flow Nasal Cannula on Sleep-disordered Breathing and Sleep Quality in Patients With Acute Stroke.

Introduction Sleep-disordered breathing (SDB) is common after stroke. Although the standard treatment of SDB is continuous positive airway pressure (CPAP) ventilation, the patient's intolerance and discomfort result in low adherence rates. Alternatively, high-flow nasal cannula (HFNC) may be useful as it reduces upper airway collapse with low level of positive pressure and well tolerability. The aim of this study was to investigate whether HFNC therapy reduces SDB and improves sleep quality with higher compliance rate. Methods We included acute stroke patients with SDB for the assessment of apnea-hypopnea index (AHI) >5/h using WatchPAT 200 (Itamar Medical Ltd, Caesarea, Israel). Patients who met inclusion criteria received HFNC therapy (40 L/min) with monitoring by WatchPAT. AHI, oxygen desaturation index (ODI), sleep efficiency, and rapid eye movement (REM) sleep were compared in patients with and without HFNC therapy. We also evaluated the patient's comfort of HFNC therapy (discomfort or not). Results Among 17 patients assessed for AHI, 12 received HFNC therapy. HFNC therapy was not adhered in two patients due to intolerance. Eight patients remained for final analysis. There were no differences in SDB and sleep quality with and without HFNC therapy as follows: HFNC therapy vs control; AHI 24.9 ± 20.1 vs 21.3 ± 15.0/h (p = 0.63), ODI 16.2 ± 16.5 vs 12.9 ± 12.3/h (p = 0.54), sleep efficiency 80.4 ± 12.9 vs 87.1 ± 6.2 (p = 0.28), percentage of REM sleep 19.4% ± 9.6% vs 27.6% ± 8.9% (p = 0.07). Two patients (17%) complained of discomfort among eight patients. Conclusion HFNC therapy did not improve SDB and sleep quality. Nonadherence and discomfort were observed in HFNC therapy. We need a large trial to confirm this result.


側弯矯正固定術後の急性換気不全に対し気管支鏡による選択的気管支拡張術が奏功した1例

日本集中治療医学会第4回中国・四国支部学術集会

日本集中治療医学会第4回中国・四国支部学術集会


ICU運営を考える「徳島大学病院救急集中治療部の概要と取り組み」

ICU運営を考える「徳島大学病院救急集中治療部の概要と取り組み」

日本集中治療医学会第4回中国・四国支部学術集会

日本集中治療医学会第4回中国・四国支部学術集会


Urinary Titin Is a Novel Biomarker for Muscle Atrophy in Nonsurgical Critically Ill Patients: A Two-Center, Prospective Observational Study.

In nonsurgical critically ill patients, urinary titin level increased 10-30 times compared with the normal level. The increased urinary titin level was associated with lower limb muscle atrophy, occurrence of ICU-acquired weakness, and ICU mortality.


ネーザルハイフロー用装置

ネーザルハイフロー用装置


急性呼吸不全を合併した免疫不全患者に対する呼吸療法がICU転帰に与える影響∼NPPVとHFNCの比較∼

Background : Non-invasive positive pressure ventilation (NPPV) is highly recommended for immunocompromised patients with acute respiratory failure. In this population it remains uncertain, however, whether high flow nasal canula(HFNC)is as beneficial as NPPV. Methods : We retrospectively studied immunocompromised patients with acute respiratory failure admitted to our ICU from 2011 to 2018. The background and clinical outcomes of patients initially treated with HFNC and NPPV were compared. Results : Upon admission, 12 patients were treated with HFNC and 10 with NPPV. While the length of ICU stay was significantly shorter in HFNC group (HFNC4．6days vs. NPPV13．8days, p=0．02), no intergroup difference was seen in ICU mortality (16．7% vs.30．0%, p=0．46)or intubation rate(33．3% vs.50．0%, p=0．43). Conclusions : For immunocompromised patients with acute respiratory failure, HFNC may be an alternative to NPPV. Further prospective investigation is warranted.


当院ICUにおけるカルバペネム系抗菌薬の使用状況とde-escalationに関する検討．

第47回日本集中治療医学会学術集会

第47回日本集中治療医学会学術集会


目標換気量の表示が人工呼吸患者の低一回換気量/肺保護換気の順守率に与える影響．

目標換気量の表示が人工呼吸患者の低一回換気量/肺保護換気の順守率に与える影響．

第47回日本集中治療医学会学術集会

第47回日本集中治療医学会学術集会


人工呼吸開始後早期の患者-人工呼吸器非同調が横隔膜厚の変化に与える影響．

人工呼吸開始後早期の患者-人工呼吸器非同調が横隔膜厚の変化に与える影響．

第47回日本集中治療医学会学術集会

第47回日本集中治療医学会学術集会


NPPVとハイフロー療法どっちがいいの?「急性呼吸不全におけるネーザルハイフローセラピーの現況」

第47回日本集中治療医学会学術集会

第47回日本集中治療医学会学術集会


Muscle atrophy in critically ill patients: a review of its cause, evaluation, and prevention

Critically ill patients exhibit prominent muscle atrophy, which occurs rapidly after ICU admission and leads to poor clinical outcomes. The extent of atrophy differs among muscles as follows: upper limb: 0.7%-2.4% per day, lower limb: 1.2%-3.0% per day, and diaphragm 1.1%-10.9% per day. This atrophy is caused by numerous risk factors such as inflammation, immobilization, nutrition, hyperglycemia, medication, and mechanical ventilation. Muscle atrophy should be monitored noninvasively by ultrasound at the bedside. Ultrasound can assess muscle mass in most patients, although physical assessment is limited to almost half of all critically ill patients due to impaired consciousness. Important strategies to prevent muscle atrophy are physical therapy and electrical muscular stimulation. Electrical muscular stimulation is especially effective for patients with limited physical therapy. Regarding diaphragm atrophy, mechanical ventilation should be adjusted to maintain spontaneous breathing and titrate inspiratory pressure. However, the sufficient timing and amount of nutritional intervention remain unclear. Further investigation is necessary to prevent muscle atrophy and improve long-term outcomes. J. Med. Invest. 67 : 1-10, February, 2020.

The Journal of Medical Investigation : JMI


Change in diaphragm and intercostal muscle thickness in mechanically ventilated patients: A prospective observational ultrasougraphy study


Effect of controlled ventilation during assist-control ventilation on diaphragm thickness : a post hoc analysis of an observational study.

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.


第47回日本救急医学会総会

第47回日本救急医学会総会


当院脳卒中センターにおける急性脳主幹動脈閉塞症例での病院前皮質症状評価の検討．

当院脳卒中センターにおける急性脳主幹動脈閉塞症例での病院前皮質症状評価の検討．

第47回日本救急医学会総会

第47回日本救急医学会総会


ステロイドパルス療法により未診断の重症筋無力症の初期増悪から呼吸不全をきたした一症例

Journal of Japanese Association for Acute Medicine


Changes of diaphragm function before and after withdrawal of high flow nasal cannula in patients with acute respiratory failure.

The 32nd Annual Congress of European Society of Intensive Care Medicine, Berlin, Germany


教育講演「非ARDS患者の人工呼吸管理」

教育講演「非ARDS患者の人工呼吸管理」

第41回日本呼吸療法医学会学術集会

第41回日本呼吸療法医学会学術集会


Long-term mobilization by a multidisciplinary team liberated a case of an acute respiratory distress syndrome (ARDS) from prolonged mechanical ventilation.

長期間の多職種連携による離床により人工呼吸器からの離脱に成功したacute respiratory distress syndrome (ARDS)の1症例

Early mobilization is an effective way to improve the physical function of critically ill patients, but there are numerous barriers to mobilization. One such is an early ward transfer. Mobilization is often insufficient in a ward, and the patient cannot be liberated from mechanical ventilation. We experienced a case of a successfully liberated patient from prolonged mechanical ventilation in long-term mobilization as orchestrated by a multidisciplinary team in the ICU. A 45-year-old female was admitted to the ICU and placed on mechanical ventilation for acute respiratory distress syndrome(ARDS). We deployed a mobilization protocol, which was mostly restricted to passive exercise in the first 2 weeks after admission. On day 30, the patient recovered from unstable respiration, but could not be liberated from mechanical ventilation because of muscle weakness, diagnosed as ICU-acquired weakness. The patient was gradually mobilized and transferred to a chair on day 35, and she was able to stand on day 56. On day 65, she was completely liberated from mechanical ventilation and discharged from the ICU 70 days after her initial admission. Long-term mobilization is important for liberation of a patient from prolonged mechanical ventilation as well as early mobilization in the ICU.


Effect of controlled ventilation on diaphragm atrophy during assist-control ventilation: a post hoc analysis.

6th SG-ANZICS Intensive Care Forum, Singapore


Timing of tracheostomy in acute stroke patients.


:座長 「口演 86(O86) 呼吸 症例 05」第46回日本集中治療医学会学術集会，2019年3月2日


Bacterial Contamination of Circuit Inner Surfaces After High-Flow Oxygen Therapy.

Bacterial contamination of inner surfaces of the circuit after high-flow oxygen therapy was relatively high.


Humidification Performance of Passive and Active Humidification Devices Within a Spontaneously Breathing Tracheostomized Cohort.

In spontaneously breathing subjects with tracheostomy, an heated-and-humidified high-flow system achieved higher absolute humidity than did an HME.


Effect of High-Flow Nasal Cannula on Thoraco-Abdominal Synchrony in Pediatric Subjects After Cardiac Surgery.

After cardiac surgery, HFNC oxygen therapy at 2 L/kg/min improved thoraco-abdominal synchrony and decreased breathing frequency in pediatric subjects. (Clinical trial registration: UMIN000023426.).


Reverse triggering induced by endotracheal tube leak in lightly sedated ARDS patient.

Reverse triggering is respiratory entrainment triggered by the ventilator especially seen among heavily sedated patients. We confirmed reverse triggering induced by auto-triggering in lightly sedated patient through an esophageal pressure monitoring. The reverse triggering frequently caused breath stacking with increased tidal volume. Physicians should be aware, even at an optimal level of sedation, that reverse triggering can develop, possibly caused by auto-triggering.


Respiratory System Mechanics During Low Versus High Positive End-Expiratory Pressure in Open Abdominal Surgery: A Substudy of PROVHILO Randomized Controlled Trial.

During mechanical ventilation with protective tidal volumes in patients undergoing open abdominal surgery, lung recruitment followed by PEEP of 12 cm H2O decreased the incidence of intratidal R/D and did not worsen overdistension, when compared to PEEP 2 cm H2O.

E was increased in the lower compared to higher PEEP group (18.6 [16⋯22] vs 13.4 [11.0⋯17.0] cm H2O·L; P < .01). %E2 was reduced in the lower PEEP group compared to higher PEEP (-15.4 [-28.0⋯6.5] vs 6.2 [-0.8⋯14.0] %; P < .05). Intratidal R/D was increased in the lower PEEP group (61% vs 22%; P = .037). The incidence of intratidal overdistension did not differ significantly between groups (6%).


特集:人工臓器の最近の進歩とケアリング:体外式膜型心肺(ECMO)の最近の進歩．

Extra Corporeal Membrane Oxygenation (ECMO) indications and usage has strikingly progressed over the last 20 years. It has become essential tool in the care of adults and children with severe cardiac and pulmonary dysfunction refractory to conventional management. Most commonly, it is instituted in an emergency or urgent situation after failure of other treatment modalities. It is used as temporary support, usually awaiting recovery of organs, or a bridging treatment to a ventricular assist device or cardiac transplantation. ECMO can be deployed in a veno-arterial configuration for the treatment of cardiogenic shock or as a tool for cardiopulmonary resuscitation. This is usually seen post cardiac surgery, septic shock, in severe cardiac failure due to almost any other cause ; cardiomyopathy, myocarditis, acute coronary syndrome with cardiogenic shock and cardiopulmonary arrest. Veno-venous ECMO is used for respiratory failure and usually involves peripheral cannulation using the femoral veins and/or internal jugular vein. The indications for veno-venous ECMO are respiratory failure, most commonly due to pneumonia, adult respiratory distress syndrome (ARDS), or primary graft failure following lung transplantation. In this article we will provide a review of ECMO development, clinical indications, complications, and patients' management while on ECMO.


Are we fully utilizing the functionalities of modern operating room ventilators?

The increase in number of new features of modern operating room ventilators clearly creates the opportunity for clinicians to optimize ventilatory care. However, improving the quality of ventilator care relies on a complete understanding and correct use of these new features. VIDEO ABSTRACT: http://links.lww.com/COAN/A47.


Upper and lower limb muscle atrophy in critically ill patients: an observational ultrasonography study.


The effect of head rotation on efficiency of face mask ventilation in anaesthetised apnoeic adults: A randomised, crossover study.

Two patients were excluded due to protocol violation; thus, data from 38 patients were analysed. The mean expiratory tidal volume was significantly higher in the rotated head position than in the neutral position (612.6 vs. 544.0 ml: difference [95% confidence interval], 68.6 [46.8 to 90.4] ml, P < 0.0001).


ER・ICUにおける手技の基本と実際―ベテランに学ぶトラブル回避法―:末梢静脈カテーテル．


FIO2 in an Adult Model Simulating High-Flow Nasal Cannula Therapy.


Evaluation of an automated endotracheal tube cuff controller during simulated mechanical ventilation.

There was a clinically important drop in manually set cuff pressure during simulated mechanical ventilation in a stationary model and an even larger drop with movement, but this was significantly reduced by the IntelliCuff in both scenarios. Additionally, we observed that cuff pressure varied directly with inspiratory airway pressure for both techniques, leading to elevated average cuff pressures.


Ventilation efficacy of video-laryngoscopes equipped with a ventilation feature.

Achieving effective ventilation is challenging for anesthesia care providers and emergency medical personnel, as difficult mask ventilation and difficult intubation frequently occur. The aim of this study was to determine whether video-laryngoscopes equipped with a ventilation feature can produce effective ventilation. An intubation mannequin with its trachea connected to a model lung with compliance 50 (normal compliance: C50) and 20 mL/cm H2O (low compliance: C20) was used. Ventilation was established via a ventilation catheter (inner diameter 3.5 mm, 50 cm length) extending to the tip of the video-laryngoscope blade. Three different views of the vocal cords (grade 1, vocal cords fully visualized; grade 2, partial vocal cord visualization; grade 3, only epiglottis visualized) were tested. Ventilation was provided by jet ventilator (Jet). The Jet was operated at 10, 15, and 20 psi (Jet10, Jet15, and Jet20). Effective tidal volume (V(T)) was defined as a V(T) greater than anatomical dead space (150 mL). In C50, Jet15 and Jet20 generated effective V(T) in all vocal cord views (for Jet15: grade 1, 663 ± 33 mL; grade 2, 363 ± 25 mL; and grade 3, 198 ± 9 mL; for Jet20: grade 1, 1,005 ± 114 mL; grade 2, 484 ± 38 mL; grade 3, 268 ± 8 mL, respectively). In C20, Jet15 and Jet20 generated effective V(T) in grades 1 and 2 (Jet15: grade 1, 288 ± 8 mL; grade 2, 160 ± 20 mL; grade 3, 81 ± 7 mL; Jet20: grade 1, 421 ± 20 mL; grade 2, 222 ± 16 mL; grade 3, 111 ± 8 mL, respectively). Jet10 achieved effective V(T) in grade 1 and 2 (grade 1, 354 ± 6 mL; grade 2, 223 ± 37 mL, respectively) in C50 and grade 1 (163 ± 12 mL) in C20. Video-laryngoscopes equipped with a ventilation feature provided effective V(T) in simulated clinical scenarios. Further clinical study is required to validate these findings.


Prognostic value of blood interleukin-6 in the prediction of functional outcome after stroke: a systematic review and meta-analysis.

We aimed to quantify the association of blood interleukin-6 (IL-6) concentrations with poor outcome after stroke and its added predictive value over clinical information. Meta-analysis of 24 studies confirmed this association with a weighted mean difference of 3.443 (1.592-5.294) pg/mL, despite high heterogeneity and publication bias. Individual participant data including 4112 stroke patients showed standardized IL-6 levels in the 4th quartile were independently associated with poor outcome (OR=2.346 (1.814-3.033), p<0.0001). However, the additional predictive value of IL-6 was moderate (IDI=1.5%, NRI=5.35%). Overall these results indicate an unlikely translation of IL-6 into clinical practice for this purpose.


Efficacy of ventilation through a customized novel cuffed airway exchange catheter: a tracheal/lung model study.


A comparison of leak compensation during pediatric noninvasive ventilation: a lung model study.

Ventilators used for noninvasive ventilation (NIV) must be able to synchronize in the presence of system leaks. We compared the ability of 7 ICU ventilators and 3 dedicated NIV ventilators to compensate for leaks during pediatric NIV. Using a lung simulator, we compared the Maquet Servo-i, Dräger V500, Dräger Carina, Covidien PB840, Respironics V60, Respironics Vision, GE Healthcare/Engström Carestation, CareFusion Avea, Hamilton C3, and Hamilton G5 during increasing (n = 6) and decreasing leaks (n = 6). With a lung simulator we tested 4 leak levels (baseline [BL] 2-3 L/min, L1 5-6 L/min, L2 9-10 L/min, and L3 19-20 L/min); 3 patient weights (10, 20, and 30 kg); and 3 lung mechanics scenarios (normal, obstructive, and restrictive). The ventilator settings were NIV mode, pressure support of 10 cm H2O, and PEEP of 5 cm H2O. The synchronization rate (synchronized cycles/total simulated respirations) was recorded for each ventilator and each leak scenario. Synchronization was defined as triggering without auto-triggering, miss-triggering, delayed cycling, or premature cycling. The mean synchronization rate across all ventilators was 68 ± 27% (range 23-96%) and marked differences existed between the ventilators (P < .001). Significant differences in synchronization rate were observed between the 10-kg model (mean 57 ± 30%, range 17-93%), the 20-kg model (69 ± 30%, 25-98%), and the 30-kg models (77 ± 22%, 28-97%) (P < .001). The synchronization rate for the obstructive model (60 ± 30%, 9-94%) was significantly different from the normal model (71 ± 29%, 18-98%) and the restrictive model (72 ± 28%, 23-98%) (P < .001). The PB840 and the C3 had synchronization rates over 90% overall across all body weights, all lung mechanic profiles, and all leak levels. Leak compensation in NIV for pediatric use can partially compensate for leaks, but varies widely among ventilators, patient weights, and lung mechanics.


Hygrometric properties of inspired gas and oral dryness in patients with acute respiratory failure during noninvasive ventilation.

Because noninvasive ventilation (NIV) delivers medical gas at high flow, inadequate humidification may cause oral dryness and patient discomfort. Heated humidification can be used during NIV, but little has been reported about the effects on the hygrometric conditions inside an oronasal mask and oral dryness during 24 hours on NIV. We measured absolute humidity (AH) inside oronasal masks on subjects with acute respiratory failure during 24 hours on NIV. A single-limb turbine ventilator and oronasal mask with an exhalation port were used for NIV. Oral moistness was evaluated using an oral moisture-checking device, and 3 times during the 24 hours the subjects subjectively scored the feeling of dryness on a 0-10 scale in which 10 was the most severe dryness. Sixteen subjects were enrolled. The mean ± SD AH inside the mask was 30.0 ± 2.6 mg H2O/L (range 23.1-33.3 mg H2O/L). The median oral moistness was 19.2% (IQR 4.4-24.0%), and the median oral dryness score was 5.5 (IQR 4-7). AH and inspired gas leak correlated inversely, both within the subjects (r = -0.56, P < .001) and between the subjects (r = -0.58, P = .02). AH and oral moistness correlated within the subjects (r = 0.39, P = .04). Oral breathing was associated with reduced oral moistness (P = .001) and increased oral dryness score (P = .002). AH varied among the subjects, and some complained of oral dryness even with heated humidifier. Oral breathing decreased oral moistness and worsened the feeling of dryness.


The nutritional needs of critically ill patients do not change according to their stage

ICU患者のエネルギー消費量と病勢との関連の検討．

Journal of the Japanese Society of Intensive Care Medicine


Incidence of bacterial contamination in infusion set needles.

We examined the incidence and types of bacterial contamination in 265 infusion set needles in adult critically ill patients. Bacterial contamination was detected in 15 samples (5.7%), and a total of 17 organisms were isolated. Ten were coagulase-negative staphylococci (CNS) and Staphylococcus aureus, and the remainder were -Streptococcus, Corynebacterium, and gram-negative rods. Although the contamination was not directly related to catheter-related bloodstream infections exchanging infusion bottles can cause intraluminal contamination and is a possible route of these infections.

AJIC - American Journal of Infection Control


Two cases of cytomegalovirus colitis with thrombocytopenia and gastrointestinal bleeding during the treatment of systemic lupus erythematosus

Systemic lupus erythematosus治療中にサイトメガロウイルス腸炎による血小板減少と消化管出血が疑われた2症例


Acute cardiac failure in a pregnant woman due to thyrotoxic crisis.

Introduction. Cardiac failure during pregnancy is usually related to preeclampsia/eclampsia, rarely to hyperthyroidism. While hyperthyroidism can easily lead to hypertensive cardiac failure and may harm the fetus, it is sometimes difficult to distinguish hyperthyroidism from normal pregnancy. Case Presentation. We encountered a case of 41-year-old pregnant woman with hypertensive cardiac failure. Because we initially diagnosed as pre-eclampsia/eclampsia, Caesarian section was performed. However, her symptoms still persisted after delivery. After thyroid function test results taken on the day of admission were obtained on the fourth day, we could diagnose that her cardiac failure was caused by thyrotoxic crisis. Conclusions. Hypertensive cardiac failure due to hyperthyroidism during pregnancy is rare and difficult to diagnose because of similar presentation of normal pregnancy. However, physicians should be aware of the risks posed by hyperthyroidism during pregnancy.


Change in ratio of observed to expected deaths in pediatric patients after implementing a closed policy in an adult ICU that admits children.

Backgrounds. We examined the effect on the prognosis of critically ill pediatric patients after a closed ICU policy was implemented into an adult ICU that admitted children. Materials and Methods. We assessed the Pediatric Index of Mortality 2 (PIM2) score of pediatric patients (≤15 y.o.) admitted to the ICU from 2001 to 2009. In our teaching hospital, the department for intensive care was established in January 2004. Since then, for critical care patients, we have followed a closed ICU policy with full-time intensivists. We subsequently compared PIM2 scores and the ratio of observed-to-expected deaths (O/E ratio) for three three-year periods: 2001-2003 (before closed policy), 2004-2006, and 2007-2009. Results. Data was collected from 532 pediatric patients. While the PIM2 score statistically significantly increased from 0.066 ± 0.130 for 2001-2003 to 0.114 ± 0.239 for 2004-2006 and 0.086 ± 0.147 for 2007-2009, the O/E ratio decreased from 1.49 for 2001-2003 to 0.82 for 2004-2006 and remained at 0.82 for 2007-2009. Conclusion. The O/E ratio for critically ill pediatric patients improved after the establishment of a closed policy in an adult ICU that admitted children.


Molecular mechanisms of the inhibitory effects of clonidine on vascular adenosine triphosphate-sensitive potassium channels.

We investigated the effects of the imidazoline-derived α2-adrenoceptor agonist clonidine on vascular adenosine triphosphate-sensitive potassium (K(ATP)) channel activity in rat vascular smooth muscle cells and recombinant vascular K(ATP) channels transiently expressed in COS-7 cells. Using the patch-clamp method, we investigated the effects of clonidine on the following: (1) native vascular K(ATP) channels; (2) recombinant K(ATP) channels with different combinations of various types of inwardly rectifying potassium channel (Kir6.0 family: Kir6.1, 6.2) and sulfonylurea receptor (SUR1, 2A, 2B) subunits; (3) SUR-deficient channels derived from a truncated isoform of the Kir6.2 subunit (Kir6.2ΔC36 channels); and (4) mutant Kir6.2ΔC36 channels with diminished sensitivity to ATP (Kir6.2ΔC36-K185Q channels). Clonidine (≥3 × 10(-8) M) inhibited native K(ATP) channel activity in cell-attached configurations with a half-maximal inhibitory concentration value of 1.21 × 10(-6) M and in inside-out configurations with a half-maximal inhibitory concentration value of 0.89 × 10(-6) M. With similar potency, clonidine (10(-6) or 10(-3) M) also inhibited the activities of various recombinant SUR/Kir6.0 K(ATP) channels, the Kir6.2ΔC36 channel, and the Kir6.2ΔC36-K185Q channel. Clinically relevant concentrations of clonidine inhibit K(ATP) channel activity in vascular smooth muscle cells. This inhibition seems to be the result of its effect on the Kir6.0 subunit and not on the SUR subunit.


A bench study of the effects of leak on ventilator performance during noninvasive ventilation.

Some of the ventilators compensated for leak better than others. With the larger leak none of the ventilators maintained the set PEEP or pressure support.


A Chest computed tomography of a patient revealing severe hypoxia due to amniotic fluid embolism: a case report.

ABSTRACT: INTRODUCTION: Amniotic fluid embolism is one of the most severe complications in the peripartum period. Because its onset is abrupt and fulminant, it is unlikely that there will be time to examine the condition using thoracic computed tomography (CT). We report a case of life-threatening amniotic fluid embolism, where chest CT in the acute phase was obtained. CASE PRESENTATION: A 22-year-old Asian Japanese primiparous woman was suspected of having an amniotic fluid embolism. After a Cesarean section for cephalopelvic disproportion, her respiratory condition deteriorated. Her chest CT images were examined. CT findings revealed diffuse homogeneous ground-glass shadow in her bilateral peripheral lung fields. She was therefore transferred to our hospital. On admission to our hospital's intensive care unit, she was found to have severe hypoxemia, with SpO2 of 50% with a reservoir mask of 15 L/min oxygen. She was intubated with the support of noninvasive positive pressure ventilation. She was successfully extubated on the sixth day, and discharged from the hospital on the twentieth day. CONCLUSION: This is the first case report describing amniotic fluid embolism in which CT revealed an acute respiratory distress syndrome-like shadow.


脳神経疾患とバイタルサイン．

脳神経疾患とバイタルサイン．


集中治療室closed化の心臓血管外科術後患者予後への影響

集中治療室closed化の心臓血管外科術後患者予後への影響


非侵襲的陽圧換気を用いて気管挿管を回避しえた重症急性膵炎による急性呼吸促迫症候群の1例


Low-density lipoprotein apheresis in a pediatric patient with refractory nephrotic syndrome due to focal segmental glomerulosclerosis

Focal segmental glomerulosclerosis (FSGS) often leads to refractory nephrotic syndrome (NS). A high level of low-density lipoprotein (LDL) is a risk factor for the progression of NS. An 8-year-old girl presented with severe proteinuria refractory to steroid therapy. She was diagnosed with non-IgA diffuse mesangial proliferative glomerulonephritis. Oral prednisolone, methylprednisolone (mPL) pulse therapy, and cyclosporine and cyclophosphamide therapy failed to achieve remission. Follow-up renal biopsy revealed FSGS. Her serum level of LDL was high, and LDL-apheresis (LDL-A) was performed five times, followed by mPL pulse therapy. Urinary protein decreased from 2-4 g x day(-) to 0.5-1.0 g x day(-). LDL-A may be beneficial in the treatment of multidrug-resistant FSGS.


Heart failure after extubation due to coronary steal phenomenon in tetralogy of Fallot

冠盗血現象のため抜管後に心不全に陥った Fallot 四徴症の一症例

Journal of the Japanese Society of Intensive Care Medicine


Plasma proinflammatory and anti-inflammatory cytokine and catecholamine concentrations as predictors of neurological outcome in acute stroke patients

Proinflammatory and anti-inflammatory cytokines may play a pivotal role in cerebral inflammation, which is implicated in the development of brain injury. Systemic cytokine release is mediated by the sympathetic nervous system and catecholamines. The aim of this study was to investigate which parameters, among plasma levels of interleukin-1beta (IL-1beta), interleukin-6 (IL-6), interleukin-10 (IL-10), and tumor necrosis factor alpha (TNF-alpha) and the levels of the catecholamines, epinephrine and norepinephrine, contribute to the clinical outcome in acute stroke patients. Thirty-seven acute stroke patients (ischemic, n = 19; hemorrhagic, n = 18) were enrolled. All of them were admitted to our hospital within 8 h after stroke onset. Neurological status was evaluated by a modified National Institute of Health Stroke Scale (mNIHSS) on admission and by a modified Rankin Scale (mRS) at 1 month. An mRS score of 3 or more at 1 month was considered to indicate poor outcome. Serum samples for the cytokine and catecholamine measurements were collected on admission. Plasma levels of IL-1beta, IL-6, IL-10, and TNF-alpha were determined by an enzyme-linked immunosorbent assay (ELISA) method and epinephrine and norepinephrine concentrations were determined by high-performance liquid chromatography with electrochemical detection (HPLC-EC). In the ischemic stroke patients, poor outcome was noted in 9 (47%). There were no significant differences in cytokine or catecholamine concentrations between patients with poor and good outcomes, and there was no association between clinical outcome and cytokine and catecholamine concentrations. In the hemorrhagic stroke patients, poor outcome was noted in 10 (56%). IL-6 and IL-10 levels were higher in patients with poor outcome. On logistic regression analysis, higher values of IL-6 were significantly associated with clinical outcome at 1 month (odds ratio [OR], 1.25; 95% confidence interval [CI], 1.02-1.54). In ischemic stroke, plasma cytokines and catecholamines were not predictors of neurological outcome at 1 month. In hemorrhagic stroke, high levels of IL-6 in the early phase indicated a poor neurological outcome.


Influence of leukocytapheresis therapy for ulcerative colitis on anemia and hemodynamics.

In Japan, leukocytapheresis (LCAP) therapy has been carried out for ulcerative colitis as an effective therapy with a low incidence of side-effects. In the present study, we serially investigated the influence of LCAP therapy on anemia and hemodynamics in patients with ulcerative colitis using a non-invasive method with a Crit-Line monitor (CLM) (Hema Metrics Inc., Salt Lake City, UT and Boston, MA, USA). We carried out LCAP on 10 patients with ulcerative colitis using a CS-100 Cellsorba EX LCAP filter in 34 courses of LCAP. The mean hematocrit value, which was measured using the Crit-Line monitor, was 21.8 +/- 0.2% (21.0-22.4%), which showed no significant changes after each LCAP therapy. The actual erythrocyte count, hemoglobin and hematocrit values decreased by 244 000/mm3, 0.7 g/dL and 2.1%, respectively, however, the differences were insignificant. These values corresponded to 7.8, 8.0 and 7.6% of the values before LCAP, respectively. There were no significant changes in systolic blood pressure, diastolic blood pressure, or heart rate during LCAP. The results of this study suggest that one course of LCAP does not exacerbate anemia, and it does not influence hemodynamics. However, considering the exacerbation of anemia in patients with severe ulcerative colitis caused by massive melena, monitoring with a less invasive Crit-Line monitor and a vital information monitor might be useful.


人工呼吸に付随する諸問題:鎮痛鎮静薬 --- 呼吸管理2020-21 ガイドライン，スタンダード，論点そして私見


熱傷治療中にabdominal compartment syndrome (ACS)の危険性から回避した症例


心膜切開後症候群に対してアスピリンが有用であった小児症例

心膜切開後症候群に対してアスピリンが有用であった小児症例


包括評価制度導入後の潰瘍性大腸炎に対する白血球除去療法

包括評価制度導入後の潰瘍性大腸炎に対する白血球除去療法


包括評価制度導入後の急性血液浄化療法

包括評価制度導入後の急性血液浄化療法