12201
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Salihefendic N, Zildzic M, Ahmetagic S. Acute Respiratory Distress Syndrome (ARDS) from Endemic Influenza A/H1N1: Prehospital Management. Med Arch 2015; 69:62-3. [PMID: 25870483 PMCID: PMC4384846 DOI: 10.5455/medarh.2015.69.62-63] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2014] [Accepted: 02/08/2015] [Indexed: 01/01/2023] Open
Abstract
Acute respiratory distress syndrome (ARDS) is a form of acute life threatening respiratory failure. In daily practice there is difficulty in diagnostic and therapeutic management of Acute respiratory distress syndrome (ARDS). We observed delay in diagnostic and therapeutic procedures in patients with clinical signs for the presence of severe respiratory disorders. Finding timely evidence of the presence the clinical signs of threatening ARDS and underlying diseases like influenza A/H1N1 during prehospital period in early stage of disease it is possible introduce early adequate treatment: high flow oxygen, fluid replacement and pharmacological and antiviral therapy. This measure can reduce high mortality in patients who develop ARDS. It is important to improve diagnostic criteria for a precise definition of ARDS and transfer it in practice of emergency and family medicine, microbiology, intensive care units, hospital departments of infectious and respiratory diseases. In this article we underlined the key elements of the new definition of ARDS, diagnostic criteria and the importance of early diagnosis in prehospital period following clinical feature and course (a presence of severe dyspnea) by adding chest x-ray and laboratory investigations.
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Affiliation(s)
- Nizama Salihefendic
- Department of Emergency medicine, Faculty of medicine, University Tuzla Bosnia and Herzegovina
| | | | - Sead Ahmetagic
- Department of Infectious diseases University clinical center Tuzla Bosnia and Herzegovina
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12202
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Cuesta-Frau D, Varela-Entrecanales M, Valor-Perez R, Vargas B. Development of a novel scheme for long-term body temperature monitoring: a review of benefits and applications. J Med Syst 2015; 39:209. [PMID: 25690997 DOI: 10.1007/s10916-015-0209-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2014] [Accepted: 11/25/2014] [Indexed: 10/24/2022]
Abstract
Body temperature is a health or disease marker that has been in clinical use for centuries. The threshold currently applied to define fever, with small variations, is 38 °C. However, current approaches do not provide a full picture of the thermoregulation process and its correlation with disease. This paper describes a new non-invasive body temperature device that improves the understanding of the pathophysiology of diseases by integrating a variety of temperature data from different body locations. This device enables to gain a deeper insight into fever, endogenous rhythms, subject activity and ambient temperature to provide anticipatory and more efficient treatments. Its clinical use would be a big step in the overcoming of the anachronistic febrile/afebrile dichotomy and walking towards a system medicine approach to certain diseases. This device has already been used in some clinical applications successfully. Other possible applications based on the device features and clinical requirements are also described in this paper.
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Affiliation(s)
- David Cuesta-Frau
- Technological Institute of Informatics, Polytechnic University of Valencia, Alcoi Campus, Plaza Ferrandiz y Carbonell, 2, 03801, Alcoi, Spain,
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12203
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Hifumi T, Taki H, Yamamoto A, Ato M, Koido Y, Kuroda Y. Update of antivenom supply for redback spider bites in Japan. J Intensive Care 2015; 3:7. [PMID: 25705432 PMCID: PMC4336267 DOI: 10.1186/s40560-014-0070-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2014] [Accepted: 12/29/2014] [Indexed: 11/10/2022] Open
Abstract
In autumn 2014, with great effort by the Ministry of Health, Labour and Welfare, the research group will obtain several vials of redback spider (RBS) antivenom for emergency use. However, these small amounts of antivenom are insufficient to cover the demands from majority of hospitals in Japan. The research group carefully discussed the domestic RBS antivenom production by themselves for this emergency. We have now entered the second stage for large-scale antivenom production. Although the domestic production of RBS antivenom has started, great caution is required as we move forward with this plan.
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Affiliation(s)
- Toru Hifumi
- Emergency Medical Center, Kagawa University Hospital, 1750-1 Ikenobe, Miki, Kita, Kagawa 761-0793 Japan
| | - Hisashi Taki
- Ministry of Health, Labour and Welfare, 1-2-2 Kasumigaseki Chiyoda-ku, Tokyo, 100-8916 Japan
| | - Akihiko Yamamoto
- Department of Bacteriology II, National Institute of Infectious Disease, Gakuen 4-7-1, Musashimurayama-shi, Tokyo, 208-0011 Japan
| | - Manabu Ato
- Department of Immunology, National Institute of Infectious Disease, Toyama 1-23-1, Shinjuku-ku, Tokyo, 162-8640 Japan
| | - Yuichi Koido
- Division of Critical Care Medicine and Trauma, National Hospital Organization Disaster Medical Center, 3256 Midori-cho, Tachikawa, Tokyo, 190-0014 Japan
| | - Yasuhiro Kuroda
- Emergency Medical Center, Kagawa University Hospital, 1750-1 Ikenobe, Miki, Kita, Kagawa 761-0793 Japan
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12204
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Schiffer D, Verient V, Luschnig D, Blokhuis‐Arkes MHE, Palen JVD, Gamerith C, Burnet M, Sigl E, Heinzle A, Guebitz GM. Lysozyme‐responsive polymer systems for detection of infection. Eng Life Sci 2015. [DOI: 10.1002/elsc.201400145] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Affiliation(s)
- Doris Schiffer
- Austrian Centre of Industrial Biotechnology Graz Austria
| | | | | | | | - J. V. D. Palen
- Medical School TwenteMedisch Spectrum Twente, Enschede, and Department of Research Methodology, Measurement, and Data AnalysisUniversity of Twente Enschede The Netherlands
| | | | | | - Eva Sigl
- Austrian Centre of Industrial Biotechnology Graz Austria
| | - Andrea Heinzle
- Austrian Centre of Industrial Biotechnology Graz Austria
| | - Georg M. Guebitz
- Institute for Environmental BiotechnologyUniversity of Natural Resources and Life Sciences Vienna Tulln an der Donau Austria
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12205
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Hashemian SM, Mahmoodpoor A, Mohajerani SA, Jamaati H. Critical care medicine education in Middle East, FCCS/BASIC course, common purpose, different method. Int J Crit Illn Inj Sci 2015; 4:318-9. [PMID: 25625066 PMCID: PMC4296337 DOI: 10.4103/2229-5151.147543] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Affiliation(s)
- Seyed Mohammadreza Hashemian
- Chronic Respiratory Disease Research Center, National Research Institute of Tuberculosis and Lung Disease, Masih Daneshvari Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Ata Mahmoodpoor
- Department Critical Care Medicine, Chronic Respiratory Disease Research Center, National Research Institute of Tuberculosis and Lung Disease, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Seyed Amir Mohajerani
- Chronic Respiratory Disease Research Center, National Research Institute of Tuberculosis and Lung Disease, Masih Daneshvari Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Hamidreza Jamaati
- Chronic Respiratory Disease Research Center, National Research Institute of Tuberculosis and Lung Disease, Masih Daneshvari Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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12206
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Dhulkhed V, Dhulkhed P, Khyadi S, Kadam A. A home brewed low cost cuff inflator and pressure monitor. Indian J Anaesth 2015. [PMID: 26195847 PMCID: PMC4481770 DOI: 10.4103/0019-5049.158793] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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12207
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Nomura S. Critically ill Patients and Platelet-Derived Microparticles. J Atheroscler Thromb 2015; 22:752-3. [DOI: 10.5551/jat.ed019] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Affiliation(s)
- Shosaku Nomura
- First Department of Internal Medicine, Kansai Medical University
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12208
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INOUE K, OZAWA Y, TOYO'OKA T. Application of Liquid Chromatography Coupled with Electrospray Ionization Tandem Mass Spectrometry for Therapeutic Drug Monitoring of Sedative Medicine in Clinical Stage. CHROMATOGRAPHY 2015. [DOI: 10.15583/jpchrom.2015.020] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Affiliation(s)
- Koichi INOUE
- College of Pharmaceutical Sciences, Ritsumeikan University
| | - Yuta OZAWA
- School of Pharmaceutical Sciences, University of Shizuoka
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12209
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Tagami T, Tosa R, Omura M, Fukushima H, Kaneko T, Endo T, Rinka H, Murai A, Yamaguchi J, Yoshikawa K, Saito N, Uzu H, Kase Y, Takatori M, Izumino H, Nakamura T, Seo R, Kitazawa Y, Sugita M, Takahashi H, Kuroki Y, Irahara T, Kanemura T, Yokota H, Kushimoto S. Effect of a selective neutrophil elastase inhibitor on mortality and ventilator-free days in patients with increased extravascular lung water: a post hoc analysis of the PiCCO Pulmonary Edema Study. J Intensive Care 2014; 2:67. [PMID: 25705423 PMCID: PMC4336272 DOI: 10.1186/s40560-014-0067-y] [Citation(s) in RCA: 60] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2014] [Accepted: 12/08/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Neutrophil elastase plays an important role in the development and progression of acute respiratory distress syndrome (ARDS). Although the selective elastase inhibitor, sivelestat, is widely used in Japan for treating ARDS patients, its effectiveness remains controversial. The aim of the current study was to investigate the effects of sivelestat in ARDS patients with evidence of increased extravascular lung water by re-analyzing a large multicenter study database. METHODS A post hoc analysis of the PiCCO Pulmonary Edema Study was conducted. This multicenter prospective cohort study included 23 institutions in Japan. Adult mechanically ventilated ARDS patients with an extravascular lung water index of >10 mL/kg were included and propensity score analyses were performed. The endpoints were 28-day mortality and ventilator-free days (VFDs). RESULTS Patients were categorized into sivelestat (n = 87) and control (n = 77) groups, from which 329 inverse probability-weighted group patients (162 vs. 167) were generated. The overall 28-day mortality was 31.1% (51/164). There was no significant difference in 28-day mortality between the study groups (sivelestat vs. control; unmatched: 29.9% vs. 32.5%; difference, -2.6%, 95% confidence interval (CI), -16.8 to 14.2; inverse probability-weighted: 24.7% vs. 29.5%, difference, -4.8%, 95% CI, -14.4 to 9.6). Although administration of sivelestat did not alter the number of ventilator-free days (VFDs) in the unmatched (9.6 vs. 9.7 days; difference, 0.1, 95% CI, -3.0 to 3.1), the inverse probability-weighted analysis identified significantly more VFDs in the sivelestat group than in the control group (10.7 vs. 8.4 days, difference, -2.3, 95% CI, -4.4 to -0.2). CONCLUSIONS Although sivelestat did not significantly affect 28-day mortality, this treatment may have the potential to increase VFDs in ARDS patients with increased extravascular lung water. Prospective randomized controlled studies are required to confirm the results of the current study.
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Affiliation(s)
- Takashi Tagami
- Department of Emergency and Critical Care Medicine, Nippon Medical School, 1-1-5 Sendagi, Bunkyo-ku, Tokyo 113-8603 Japan ; Department of Clinical Epidemiology and Health Economics, School of Public Health, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Ryoichi Tosa
- Department of Emergency and Critical Care Medicine, Aizu Chuo Hospital, Fukushima, Japan
| | - Mariko Omura
- Department of Emergency and Critical Care Medicine, Aizu Chuo Hospital, Fukushima, Japan
| | - Hidetada Fukushima
- Department of Emergency and Critical Care Medicine, Nara Medical University, Nara, Japan
| | - Tadashi Kaneko
- Advanced Medical Emergency and Critical Care Center, Yamaguchi University Hospital, Yamaguchi, Japan
| | - Tomoyuki Endo
- Department of Emergency and Critical Care Medicine, Tohoku University Hospital, Miyagi, Japan
| | - Hiroshi Rinka
- Emergency and Critical Care Medical Center, Osaka City General Hospital, Osaka, Japan
| | - Akira Murai
- Department of Emergency and Critical Care Medicine, Faculty of Medicine, Fukuoka University, Fukuoka, Japan
| | - Junko Yamaguchi
- Division of Emergency and Critical Care Medicine, Department of Acute Medicine, Nihon University School of Medicine, Tokyo, Japan
| | - Kazuhide Yoshikawa
- Shock Trauma and Emergency Medical Center, Tokyo Medical and Dental University Hospital of Medicine, Tokyo, Japan
| | - Nobuyuki Saito
- Department of Emergency and Critical Care Medicine, Nippon Medical School Chiba Hokusou Hospital, Chiba, Japan
| | - Hideaki Uzu
- Department of Emergency and Critical Care Medicine, Kurume University School of Medicine, Fukuoka, Japan
| | - Yoichi Kase
- Critical Care Medicine, Jikei University School of Medicine, Tokyo, Japan
| | - Makoto Takatori
- Department of Anesthesia and Intensive Care, Hiroshima City Hospital, Hiroshima, Japan
| | - Hiroo Izumino
- Advanced Emergency and Critical Care Center, Kansai Medical University Takii Hospital, Osaka, Japan
| | | | - Ryutarou Seo
- Intensive Care Unit, Kobe City Medical Center General Hospital, Hyogo, Japan
| | - Yasuhide Kitazawa
- Department of Emergency and Critical Care Medicine, Kansai Medical University, Osaka, Japan
| | - Manabu Sugita
- Department of Emergency and Critical Care Medicine, Juntendo University Nerima Hospital, Tokyo, Japan
| | - Hiroyuki Takahashi
- Department of Intensive Care Medicine, Saiseikai Yokohamashi Tobu Hospital, Kanagawa, Japan
| | - Yuichi Kuroki
- Department of Emergency and Critical Care Medicine, Social Insurance Chukyo Hospital, Aichi, Japan
| | - Takayuki Irahara
- Department of Emergency and Critical Care Medicine, Nippon Medical School Tama Nagayama Hospital, Tokyo, Japan
| | - Takashi Kanemura
- Emergency and Critical Care Medicine, National Hospital Organization Disaster Medical Center, Tokyo, Japan
| | - Hiroyuki Yokota
- Department of Emergency and Critical Care Medicine, Nippon Medical School, 1-1-5 Sendagi, Bunkyo-ku, Tokyo 113-8603 Japan
| | - Shigeki Kushimoto
- Division of Emergency Medicine, Tohoku University Graduate School of Medicine, Miyagi, Japan
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12210
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Sawa T, Shimizu M, Moriyama K, Wiener-Kronish JP. Association between Pseudomonas aeruginosa type III secretion, antibiotic resistance, and clinical outcome: a review. CRITICAL CARE : THE OFFICIAL JOURNAL OF THE CRITICAL CARE FORUM 2014; 18:668. [PMID: 25672496 PMCID: PMC4331484 DOI: 10.1186/s13054-014-0668-9] [Citation(s) in RCA: 83] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Pseudomonas aeruginosa uses a complex type III secretion system to inject the toxins ExoS, ExoT, ExoU, and ExoY into the cytosol of target eukaryotic cells. This system is regulated by the exoenzyme S regulon and includes the transcriptional activator ExsA. Of the four toxins, ExoU is characterized as the major virulence factor responsible for alveolar epithelial injury in patients with P. aeruginosa pneumonia. Virulent strains of P. aeruginosa possess the exoU gene, whereas non-virulent strains lack this particular gene. The mechanism of virulence for the exoU+ genotype relies on the presence of a pathogenic gene cluster (PAPI-2) encoding exoU and its chaperone, spcU. The ExoU toxin has a patatin-like phospholipase domain in its N-terminal, exhibits phospholipase A2 activity, and requires a eukaryotic cell factor for activation. The C-terminal of ExoU has a ubiquitinylation mechanism of activation. This probably induces a structural change in enzymatic active sites required for phospholipase A2 activity. In P. aeruginosa clinical isolates, the exoU+ genotype correlates with a fluoroquinolone resistance phenotype. Additionally, poor clinical outcomes have been observed in patients with pneumonia caused by exoU+-fluoroquinolone-resistant isolates. Therefore, the potential exists to improve clinical outcomes in patients with P. aeruginosa pneumonia by identifying virulent and antimicrobial drug-resistant strains through exoU genotyping or ExoU protein phenotyping or both.
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12211
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Wandt H, Schäfer-Eckart K, Greinacher A. Platelet transfusion in hematology, oncology and surgery. DEUTSCHES ARZTEBLATT INTERNATIONAL 2014; 111:809-15. [PMID: 25512006 PMCID: PMC4269073 DOI: 10.3238/arztebl.2014.0809] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/26/2014] [Revised: 09/15/2014] [Accepted: 09/15/2014] [Indexed: 11/27/2022]
Abstract
BACKGROUND The standard recommendation to date has been that acute hypoproliferative thrombocytopenia should be treated with a prophylactic platelet transfusion if the morning platelet count is less than 10 000/μL, or less than 20 000/μL if there are additional risk factors. For chronic thrombocytopenia, transfusion has been recommended if the platelet count is less than 5000/μL. In Germany, half a million platelet transfusions are now being given every year, and the number is rising. New studies indicate, however, that a more restrictive transfusion strategy is justified. METHODS A selective literature search was carried out in PubMed, with additional attention to recommendations from Germany and abroad, and to the guidelines of medical specialty societies. RESULTS Prophylactic platelet transfusions should be given when clinically indicated in consideration of the individual hemorrhagic risk. To prevent severe hemorrhage, it is more important to respond to the first signs of bleeding than to pay exclusive attention to morning platelet counts below 10 000/μL. This threshold value remains standard for patients with acute leukemia. According to recent studies, however, clinically stable patients who are at low risk for bleeding-e.g., patients who have undergone autologous hematopoietic stem-cell transplantation-may be well served by a therapeutic, rather than prophylactic, platelet transfusion strategy, in which platelets are transfused only when evidence of bleeding has been observed. For cancer patients, intensive-care patients, and patients with other risk factors, a clinically oriented transfusion strategy is recommended, in addition to close attention to threshold platelet values. CONCLUSION The number of platelet transfusions could be safely lowered by a more restrictive transfusion strategy that takes account of the risk of bleeding, as recommended in the hemotherapy guidelines.
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Affiliation(s)
- Hannes Wandt
- Medical Clinic 5—Nuremberg Hospital: Internal Medicine, Oncology, Hematology
| | | | - Andreas Greinacher
- Institute of Immunology and Transfusion Medicine, Ernst-Moritz-Arndt-University of Greifswald
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12212
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Otsui K, Yamamoto M, Aoki H, Ozawa T, Domoto K, Suzuki A, Iwata S, Takei A, Inamoto S, Inoue N. A super-elderly case of abdominal aortic aneurysm associated with chronic disseminated intravascular coagulation. J Cardiol Cases 2014; 11:48-51. [PMID: 30534257 DOI: 10.1016/j.jccase.2014.10.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2014] [Revised: 09/25/2014] [Accepted: 10/09/2014] [Indexed: 11/30/2022] Open
Abstract
Chronic disseminated intravascular coagulation (DIC) is a well-known complication of aortic aneurysm. A 91-year-old Japanese woman was admitted to our hospital because of massive purpura of the lower limbs. The presence of abdominal aortic aneurysm (AAA) had been pointed out from the age of 80 years, and its diameter had gradually increased. The AAA was composed of two portions, that is, a large upper and a small lower portion, and a large mural thrombosis was observed in the lower portion. The laboratory data led to the diagnosis of DIC, and AAA was the only identifiable cause of coagulopathy. The time course of exacerbation of AAA was consistent with the progression of thrombocytopenia and purpura. Therefore, we concluded that AAA was the underlying cause of DIC. Since DIC in aortic aneurysms is associated with excessive fibrinolysis, tranexamic acid was administered as anti-fibrinolytic therapy. After that, coagulopathy was drastically improved. Our patient responded successfully to anti-fibrinolytic therapy for coagulopathy. The present case illustrates the importance of evaluation of the diameter of an aneurysm as well as intraluminal thrombosis, which may play an important role in coagulopathy including DIC. It is necessary to monitor coagulation and fibrinolysis for the follow-up of patients with AAA. <Learning objective: We present a case report of an aged Japanese woman with abdominal aortic aneurysm associated with disseminated intravascular coagulation, and anti-fibrinolytic therapy drastically ameliorated her condition. Our case illustrates the importance of evaluation of the diameter of an aneurysm as well as conducting follow-up monitoring of coagulation and fibrinolysis.>.
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Affiliation(s)
- Kazunori Otsui
- Department of Cardiovascular Medicine, Kobe Rosai Hospital, Kobe, Japan
| | - Mai Yamamoto
- Department of General Medicine, Kobe Rosai Hospital, Kobe, Japan
| | - Humiaki Aoki
- Department of General Medicine, Kobe Rosai Hospital, Kobe, Japan
| | - Toru Ozawa
- Department of Cardiovascular Medicine, Kobe Rosai Hospital, Kobe, Japan
| | - Koji Domoto
- Department of General Medicine, Kobe Rosai Hospital, Kobe, Japan
| | - Atsushi Suzuki
- Department of Cardiovascular Medicine, Kobe Rosai Hospital, Kobe, Japan
| | - Sachiyo Iwata
- Department of Cardiovascular Medicine, Kobe Rosai Hospital, Kobe, Japan
| | - Asumi Takei
- Department of Cardiovascular Medicine, Kobe Rosai Hospital, Kobe, Japan
| | - Shinya Inamoto
- Department of General Medicine, Kobe Rosai Hospital, Kobe, Japan
| | - Nobutaka Inoue
- Department of Cardiovascular Medicine, Kobe Rosai Hospital, Kobe, Japan
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12213
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Tibrewal S, Ivanir Y, Sarkar J, Nayeb-Hashemi N, Bouchard CS, Kim E, Jain S. Hyperosmolar stress induces neutrophil extracellular trap formation: implications for dry eye disease. Invest Ophthalmol Vis Sci 2014; 55:7961-9. [PMID: 25406284 PMCID: PMC4263134 DOI: 10.1167/iovs.14-15332] [Citation(s) in RCA: 53] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2014] [Accepted: 10/26/2014] [Indexed: 12/13/2022] Open
Abstract
PURPOSE To determine if hyperosmolar stress can stimulate human neutrophils to form neutrophil extracellular traps (NETs) and to investigate potential strategies to reduce formation of NETs (NETosis) in a hyperosmolar environment. METHODS Neutrophils were isolated from peripheral venous blood of healthy subjects and incubated in iso-osmolar (280 mOsM) or hyperosmolar (420 mOsM) media for 4 hours. Neutrophil extracellular traps were quantified using a PicoGreen dye assay to measure extracellular DNA. Two known inhibitors of NETosis, staurosporine and anti-β2 integrin blocking antibody, and two proresolution formyl peptide receptor 2 (FPR2) agonists, annexin/lipocortin-1 mimetic peptide and 15-epi-lipoxin A4, were evaluated as possible strategies to reduce hyperosmolarity-induced NETosis. RESULTS The amount of NETs induced by hyperosmolar medium (420 mOsM) increased linearly over time to 3.2 ± 0.3 times that induced by iso-osmolar medium at 4 hours (P < 0.05). NETosis increased exponentially with increasing osmolarity and was independent of the stimulus used to increase osmolarity. Upon neutrophil exposure to hyperosmolar stress, restoration of iso-osmolar conditions decreased NET formation by 52.7% ± 5% (P < 0.05) but did not completely abrogate it. Among the strategies tested to reduce NETosis in a hyperosmolar environment, annexin-1 peptide was the most efficacious. CONCLUSIONS Hyperosmolarity induces formation of NETs by neutrophils. This NETosis mechanism may explain the presence of excessive NETs on the ocular surface of patients with dry eye disease. Because they reduce hyperosmolarity-induced NETosis, FPR2 agonists may have therapeutic potential in these patients.
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Affiliation(s)
- Sapna Tibrewal
- Corneal Neurobiology Laboratory, Department of Ophthalmology and Visual Sciences, University of Illinois at Chicago, College of Medicine, Chicago, Illinois, United States
| | - Yair Ivanir
- Corneal Neurobiology Laboratory, Department of Ophthalmology and Visual Sciences, University of Illinois at Chicago, College of Medicine, Chicago, Illinois, United States
| | - Joy Sarkar
- Corneal Neurobiology Laboratory, Department of Ophthalmology and Visual Sciences, University of Illinois at Chicago, College of Medicine, Chicago, Illinois, United States
| | - Neema Nayeb-Hashemi
- Department of Ophthalmology, Loyola University Chicago Stritch School of Medicine, Maywood, Illinois, United States
| | - Charles S. Bouchard
- Department of Ophthalmology, Loyola University Chicago Stritch School of Medicine, Maywood, Illinois, United States
| | - Eunjae Kim
- Corneal Neurobiology Laboratory, Department of Ophthalmology and Visual Sciences, University of Illinois at Chicago, College of Medicine, Chicago, Illinois, United States
| | - Sandeep Jain
- Corneal Neurobiology Laboratory, Department of Ophthalmology and Visual Sciences, University of Illinois at Chicago, College of Medicine, Chicago, Illinois, United States
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12214
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Prowle JR, Leitch A, Kirwan CJ, Forni LG. Positive fluid balance and AKI diagnosis: assessing the extent and duration of ‘creatinine dilution’. Intensive Care Med 2014; 41:160-1. [DOI: 10.1007/s00134-014-3538-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/28/2014] [Indexed: 10/24/2022]
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12215
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Joynt GM, Lipman J, Hartog C, Guidet B, Paruk F, Feldman C, Kissoon N, Sprung CL. The Durban World Congress Ethics Round Table IV: health care professional end-of-life decision making. J Crit Care 2014; 30:224-30. [PMID: 25454075 DOI: 10.1016/j.jcrc.2014.10.011] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2014] [Revised: 10/11/2014] [Accepted: 10/14/2014] [Indexed: 11/26/2022]
Abstract
INTRODUCTION When terminal illness exists, it is common clinical practice worldwide to withhold (WH) or withdraw (WD) life-sustaining treatments. Systematic documentation of professional opinion and perceived practice similarities and differences may allow recommendations to be developed. MATERIALS AND METHODS Speakers from invited faculty of the World Federation of Societies of Intensive and Critical Care Medicine Congress that took place in Durban (2013), with an interest in ethics, were approached to participate in an ethics round table. Key domains of health care professional end-of-life decision making were defined, explored by discussion, and then questions related to current practice and opinion developed and subsequently answered by round-table participants to establish the presence or absence of agreement. RESULTS Agreement was established for the desirability for early goal-of-care discussions and discussions between health care professionals to establish health care provider consensus and confirmation of the grounds for WH/WD, before holding formal WH/WD discussions with patients/surrogates. Nurse and other health care professional involvement were common in most but not all countries/regions. Principles and practical triggers for initiating discussions on WH/WD, such as multiorgan failure, predicted short-term survival, and predicted poor neurologic outcome, were identified. CONCLUSIONS There was majority agreement for many but not all statements describing health care professional end-of-life decision making.
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Affiliation(s)
- Gavin M Joynt
- Department of Anaesthesia and Intensive Care, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, NT, Hong Kong.
| | | | - Christiane Hartog
- Center for Sepsis Control and Care, University of Jena, Jena, Germany
| | | | - Fathima Paruk
- University of the Witwatersrand, Johannesburg, South Africa
| | - Charles Feldman
- Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Niranjan Kissoon
- BC Children's Hospital, University of British Columbia, Vancouver, Canada
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12216
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Iwashita Y, Zhang E, Maruyama J, Yokochi A, Yamada Y, Sawada H, Mitani Y, Imai H, Suzuki K, Maruyama K. Thrombomodulin protects against lung damage created by high level of oxygen with large tidal volume mechanical ventilation in rats. J Intensive Care 2014; 2:57. [PMID: 25705415 PMCID: PMC4336269 DOI: 10.1186/s40560-014-0057-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2014] [Accepted: 09/17/2014] [Indexed: 12/04/2022] Open
Abstract
Background Ventilator-induced lung injury (VILI) is associated with inflammatory responses in the lung. Thrombomodulin (TM), a component of the coagulation system, has anticoagulant and anti-inflammatory effects. We hypothesized that the administration of recombinant human soluble TM (rhsTM) would block the development of lung injury. Methods Lung injury was induced by high tidal volume ventilation for 2 h with 100% oxygen in rats. Rats were ventilated with a tidal volume of 35 ml/kg with pretreatment via a subcutaneous injection of 3 mg/kg rhsTM (HV (high tidal volume)/TM) or saline (HV/SAL) 12 h before mechanical ventilation. Rats ventilated with a tidal volume of 6 ml/kg under 100% oxygen with rhsTM (LV (low tidal volume)/TM) or saline (LV/SAL) were used as controls. Lung protein permeability was determined by Evans blue dye (EBD) extravasation. Results Lung injury was successfully induced in the HV/SAL group compared with the LV/SAL group, as shown by the significant decrease in arterial oxygen pressure (PaO2), increased protein permeability, and increase in mean pulmonary artery pressure (mPAP) and ratio of mean pulmonary artery pressure to mean artery pressure (Pp/Ps). Treatment of rats with lung injury with rhsTM (HV/TM) significantly attenuated the decrease in PaO2 and the increase in both mPAP and Pp/Ps, which was associated with a decrease in the lung protein permeability. Lung tissue mRNA expressions of interleukin (IL)-1α, IL-1β, IL-6, tumor necrosis factor-α, and macrophage inflammatory protein (MIP)-2 were significantly higher in HV than in LV rats. Rats with VILI treated with rhsTM (HV/TM) had significantly lower mRNA expressions of IL-1α, IL-1β, IL-6, and MIP-2 than those expressions in HV/SAL rats. Conclusions Administration of rhsTM may prevent the development of lung injury created by high level of oxygen with large tidal volume mechanical ventilation, which has concomitant decrease in proinflammatory cytokine and chemokine expression in the lung.
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Affiliation(s)
- Yoshiaki Iwashita
- Department of Anesthesiology and Critical Care Medicine, School of Medicine, Mie University, 2-174 Edobashi, Tsu, Mie 5148507 Japan ; Department of Emergency Critical Care Center, Mie University School of Medicine, 2-174 Edobashi, Tsu, Mie 514-8507 Japan
| | - Erquan Zhang
- Department of Anesthesiology and Critical Care Medicine, School of Medicine, Mie University, 2-174 Edobashi, Tsu, Mie 5148507 Japan
| | - Junko Maruyama
- Department of Anesthesiology and Critical Care Medicine, School of Medicine, Mie University, 2-174 Edobashi, Tsu, Mie 5148507 Japan ; Department of Medical Engineering, Suzuka University of Medical Science, 1001-1 Kishiokacho, Suzuka, Mie 510-0226 Japan
| | - Ayumu Yokochi
- Department of Anesthesiology and Critical Care Medicine, School of Medicine, Mie University, 2-174 Edobashi, Tsu, Mie 5148507 Japan
| | - Yasuharu Yamada
- Department of Anesthesiology and Critical Care Medicine, School of Medicine, Mie University, 2-174 Edobashi, Tsu, Mie 5148507 Japan ; Department of Medical Engineering, Suzuka University of Medical Science, 1001-1 Kishiokacho, Suzuka, Mie 510-0226 Japan
| | - Hirofumi Sawada
- Department of Anesthesiology and Critical Care Medicine, School of Medicine, Mie University, 2-174 Edobashi, Tsu, Mie 5148507 Japan ; Department of Pediatrics, School of Medicine, Mie University, Tsu, Mie Japan
| | - Yoshihide Mitani
- Department of Pediatrics, School of Medicine, Mie University, Tsu, Mie Japan
| | - Hiroshi Imai
- Department of Emergency Critical Care Center, Mie University School of Medicine, 2-174 Edobashi, Tsu, Mie 514-8507 Japan
| | - Koji Suzuki
- Department of Pharmacological Science, Suzuka University of Medical Science, 1001-1 Kishiokacho, Suzuka, Mie 510-0226 Japan
| | - Kazuo Maruyama
- Department of Anesthesiology and Critical Care Medicine, School of Medicine, Mie University, 2-174 Edobashi, Tsu, Mie 5148507 Japan
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12217
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Tagami T, Nakamura T, Kushimoto S, Tosa R, Watanabe A, Kaneko T, Fukushima H, Rinka H, Kudo D, Uzu H, Murai A, Takatori M, Izumino H, Kase Y, Seo R, Takahashi H, Kitazawa Y, Yamaguchi J, Sugita M, Takahashi H, Kuroki Y, Kanemura T, Morisawa K, Saito N, Irahara T, Yokota H. Early-phase changes of extravascular lung water index as a prognostic indicator in acute respiratory distress syndrome patients. Ann Intensive Care 2014; 4:27. [PMID: 25593743 PMCID: PMC4273855 DOI: 10.1186/s13613-014-0027-7] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2014] [Accepted: 07/31/2014] [Indexed: 01/11/2023] Open
Abstract
Background The features of early-phase acute respiratory distress syndrome (ARDS) are leakage of fluid into the extravascular space and impairment of its reabsorption, resulting in extravascular lung water (EVLW) accumulation. The current study aimed to identify how the initial EVLW values and their change were associated with mortality. Methods This was a post hoc analysis of the PiCCO Pulmonary Edema Study, a multicenter prospective cohort study that included 23 institutions. Single-indicator transpulmonary thermodilution-derived EVLW index (EVLWi) and conventional prognostic factors were prospectively collected over 48 h after enrollment. Associations between 28-day mortality and each variable including initial (on day 0), mean, maximum, and Δ (subtracting day 2 from day 0) EVLWi were evaluated. Results We evaluated 192 ARDS patients (median age, 69 years (quartile, 24 years); Sequential Organ Failure Assessment (SOFA) score on admission, 10 (5); all-cause 28-day mortality, 31%). Although no significant differences were found in initial, mean, or maximum EVLWi, Δ-EVLWi was significantly higher (i.e., more reduction in EVLWi) in survivors than in non-survivors (3.0 vs. −0.3 mL/kg, p = 0.006). Age, maximum, and Δ-SOFA scores and Δ-EVLW were the independent predictors for survival according to the Cox proportional hazard model. Patients with Δ-EVLWi > 2.8 had a significantly higher incidence of survival than those with Δ-EVLWi ≤ 2.8 (log-rank test, χ2 = 7.08, p = 0.008). Conclusions Decrease in EVLWi during the first 48 h of ARDS may be associated with 28-day survival. Serial EVLWi measurements may be useful for understanding the pathophysiologic conditions in ARDS patients. A large multination confirmative trial is required.
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Affiliation(s)
- Takashi Tagami
- Department of Emergency and Critical Care Medicine, Nippon Medical School, 1-1-5 Sendagi, Bunkyo-ku, Tokyo 113-8603, Japan ; Department of Clinical Epidemiology and Health Economics, School of Public Health, Graduate School of Medicine, The University of Tokyo, Tokyo 113-8654, Japan
| | - Toshiaki Nakamura
- Intensive Care Unit, Nagasaki University Hospital, Nagasaki 852-8501, Japan
| | - Shigeki Kushimoto
- Division of Emergency Medicine, Tohoku University Graduate School of Medicine, Miyagi 986-2242, Japan
| | - Ryoichi Tosa
- Department of Emergency and Critical Care Medicine, Aizu Chuo Hospital, Fukushima 965-8611, Japan
| | - Akihiro Watanabe
- Department of Emergency and Critical Care Medicine, Nippon Medical School, 1-1-5 Sendagi, Bunkyo-ku, Tokyo 113-8603, Japan
| | - Tadashi Kaneko
- Advanced Medical Emergency and Critical Care Center, Yamaguchi University Hospital, Yamaguchi 755-8505, Japan
| | - Hidetada Fukushima
- Department of Emergency and Critical Care Medicine, Nara Medical University, Nara 634-8522, Japan
| | - Hiroshi Rinka
- Emergency and Critical Care Medical Center, Osaka City General Hospital, Osaka 534-0021, Japan
| | - Daisuke Kudo
- Division of Emergency Medicine, Tohoku University Graduate School of Medicine, Miyagi 986-2242, Japan
| | - Hideaki Uzu
- Department of Emergency and Critical Care Medicine, Kurume University School of Medicine, Fukuoka 830-0011, Japan
| | - Akira Murai
- Department of Emergency and Critical Care Medicine, Fukuoka University Hospital, Fukuoka 814-0180, Japan
| | - Makoto Takatori
- Department of Anesthesia and Intensive Care, Hiroshima City Hospital, Hiroshima 730-8518, Japan
| | - Hiroo Izumino
- Advanced Emergency and Critical Care Center, Kansai Medical University Takii Hospital, Osaka 570-8507, Japan
| | - Yoichi Kase
- Department of Critical Care Medicine, Jikei University School of Medicine, Tokyo 105-8461, Japan
| | - Ryutarou Seo
- Intensive Care Unit, Kobe City Medical Center General Hospital, Hyogo 650-0046, Japan
| | - Hiroyuki Takahashi
- Shock Trauma and Emergency Medical Center, Tokyo Medical and Dental University Hospital of Medicine, Tokyo 113-8519, Japan
| | - Yasuhide Kitazawa
- Department of Emergency and Critical Care Medicine, Kansai Medical University, Osaka 570-8506, Japan
| | - Junko Yamaguchi
- Division of Emergency and Critical Care Medicine, Department of Acute Medicine, Nihon University School of Medicine, Tokyo 173-8610, Japan
| | - Manabu Sugita
- Department of Emergency and Critical Care Medicine, Juntendo University Nerima Hospital, Tokyo 177-8521, Japan
| | - Hiroyuki Takahashi
- Department of Intensive Care Medicine, Saiseikai Yokohamashi Tobu Hospital, Kanagawa 230-8765, Japan
| | - Yuichi Kuroki
- Department of Emergency and Critical Care Medicine, Social Insurance Chukyo Hospital, Aichi 457-8510, Japan
| | - Takashi Kanemura
- Emergency and Critical Care Medicine, National Hospital Organization Disaster Medical Center, Tokyo 190-0014, Japan
| | - Kenichiro Morisawa
- Department of Emergency and Critical Care Medicine, St. Marianna University School of Medicine, Kanagawa 216-8511, Japan
| | - Nobuyuki Saito
- Department of Emergency and Critical Care Medicine, Nippon Medical School, Chiba Hokusou Hospital, Chiba 270-1694, Japan
| | - Takayuki Irahara
- Department of Emergency and Critical Care Medicine, Nippon Medical School, Tama Nagayama Hospital, Tokyo 206-8512, Japan
| | - Hiroyuki Yokota
- Department of Emergency and Critical Care Medicine, Nippon Medical School, 1-1-5 Sendagi, Bunkyo-ku, Tokyo 113-8603, Japan
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12218
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Hifumi T, Murakawa M, Sakai A, Ginnaga A, Yamamoto A, Ato M, Kato H, Koido Y, Kawakita K, Hagiike M, Kuroda Y. Potentially fatal coagulopathy secondary to yamakagashi ( Rhabdophis tigrinus) bites that completely recovered with antivenom treatment. Acute Med Surg 2014; 2:123-126. [PMID: 29123706 DOI: 10.1002/ams2.69] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2014] [Accepted: 06/11/2014] [Indexed: 11/06/2022] Open
Abstract
Case A healthy 40-year-old man was admitted with severe coagulopathy that developed after Rhabdophis tigrinus bites. On admission, he showed significantly elevated levels of thrombin-antithrombin III complex (60 ng/mL), plasmin-alpha 2-plasmin inhibitor complex (22.3 μg/mL), and fibrinogen degradation products (592 μg/mL). He subsequently developed severe hypofibrinogenemia (50 mg/dL). Outcome Antivenom was given 28 h after the patient was bitten, following which his hemorrhagic symptoms resolved. By day 3 of admission, scabs had formed over the bite wounds. Furthermore, his fibrinogen levels increased to >100 mg/dL, while his thrombin-antithrombin III complex, plasmin-alpha 2-plasmin inhibitor complex, and fibrinogen degradation product levels normalized. He was discharged on day 6 of admission. Conclusion Rhabdophis tigrinus bites induced disseminated intravascular coagulation with a fibrinolytic phenotype, which completely recovered with antivenom treatment.
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Affiliation(s)
- Toru Hifumi
- Emergency Medical Center Kagawa University Hospital Kagawa Japan
| | | | | | - Akihiko Ginnaga
- The Chemo-Sero-Therapeutic Research Institute Kumamoto Japan
| | - Akihiko Yamamoto
- Department of Bacteriology II National Institute of Infectious Disease Tokyo Japan
| | - Manabu Ato
- Department of Immunology National Institute of Infectious Disease Tokyo Japan
| | - Hiroshi Kato
- Division of Critical Care Medicine and Trauma National Hospital Organization Disaster Medical Center Tokyo Japan
| | - Yuichi Koido
- Division of Critical Care Medicine and Trauma National Hospital Organization Disaster Medical Center Tokyo Japan
| | - Kenya Kawakita
- Emergency Medical Center Kagawa University Hospital Kagawa Japan
| | - Masanobu Hagiike
- Emergency Medical Center Kagawa University Hospital Kagawa Japan
| | - Yasuhiro Kuroda
- Emergency Medical Center Kagawa University Hospital Kagawa Japan
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12219
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Silva A, Hifumi T, Sakai A, Yamamoto A, Murakawa M, Ato M, Shibayama K, Ginnaga A, Kato H, Koido Y, Inoue J, Abe Y, Kawakita K, Hagiike M, Kuroda Y. Rhabdophis tigrinus is not a pit viper but its bites result in venom-induced consumptive coagulopathy similar to many viper bites. J Intensive Care 2014; 2:43. [PMID: 25520845 PMCID: PMC4267603 DOI: 10.1186/s40560-014-0043-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2014] [Accepted: 06/20/2014] [Indexed: 11/22/2022] Open
Abstract
As a response to the recent article by Hifumi et al. published in the Journal of Intensive Care, the present correspondence clarifies the family-level taxonomy of the yamakagashi (Rhabdophis tigrinus). Further, the relevance of the term ‘venom-induced consumptive coagulopathy,’ instead of disseminated intravascular coagulation, in describing the procoagulant coagulopathy of R. tigrinus is highlighted.
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Affiliation(s)
- Anjana Silva
- Department of Parasitology, Faculty of Medicine and Allied Sciences, Rajarata University of Sri Lanka, Anuradhapura, Saliyapura 50008 Sri Lanka
| | - Toru Hifumi
- Emergency Medical Center, Kagawa University Hospital, 1750-1 Ikenobe, Miki, Kita, Kagawa 761-0793 Japan
| | - Atsushi Sakai
- The Japan Snake Institute, Yabutsuka 3318, Ota, Gumma 379-2301 Japan
| | - Akihiko Yamamoto
- Department of Bacteriology II, National Institute of Infectious Disease, Gakuen 4-7-1, Musashimurayama-shi, Tokyo 208-0011 Japan
| | - Masahiro Murakawa
- Department of Internal Medicine, Kaizuka Hospital, Hakosaki 7-7-27, Higashi-ku, Fukuoka 812-0053 Japan
| | - Manabu Ato
- Department of Immunology, National Institute of Infectious Disease, Toyama 1-23-1, Shinjuku-ku, Tokyo 162-8640 Japan
| | - Keigo Shibayama
- Department of Bacteriology II, National Institute of Infectious Disease, Gakuen 4-7-1, Musashimurayama-shi, Tokyo 208-0011 Japan
| | - Akihiko Ginnaga
- The Chemo-Sero-Therapeutic Research Institute (KAKETSUKEN), 1-6-1 Okubo, Kita-ku, Kumamoto-shi, Kumamoto 860-8568 Japan
| | - Hiroshi Kato
- Division of Critical Care Medicine and Trauma, National Hospital Organization Disaster Medical Center, 3256 Midori-cho, Tachikawa, Tokyo 190-0014 Japan
| | - Yuichi Koido
- Division of Critical Care Medicine and Trauma, National Hospital Organization Disaster Medical Center, 3256 Midori-cho, Tachikawa, Tokyo 190-0014 Japan
| | - Junichi Inoue
- Division of Critical Care Medicine and Trauma, Yamanashi Prefectural Central Hospital, 1-1-1 Fujimicho, Kofu, Yamanashi 400-8506 Japan
| | - Yuko Abe
- Emergency Medical Center, Kagawa University Hospital, 1750-1 Ikenobe, Miki, Kita, Kagawa 761-0793 Japan
| | - Kenya Kawakita
- Emergency Medical Center, Kagawa University Hospital, 1750-1 Ikenobe, Miki, Kita, Kagawa 761-0793 Japan
| | - Masanobu Hagiike
- Emergency Medical Center, Kagawa University Hospital, 1750-1 Ikenobe, Miki, Kita, Kagawa 761-0793 Japan
| | - Yasuhiro Kuroda
- Emergency Medical Center, Kagawa University Hospital, 1750-1 Ikenobe, Miki, Kita, Kagawa 761-0793 Japan
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12220
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Hifumi T, Sakai A, Yamamoto A, Murakawa M, Ato M, Shibayama K, Kato H, Koido Y, Inoue J, Abe Y, Kawakita K, Hagiike M, Ginnaga A, Kuroda Y. Effect of antivenom therapy of Rhabdophis tigrinus (Yamakagashi snake) bites. J Intensive Care 2014; 2:44. [PMID: 25520846 PMCID: PMC4267595 DOI: 10.1186/s40560-014-0044-5] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2014] [Accepted: 06/23/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Rhabdophis tigrinus (Yamakagashi snake) is a rear-fanged colubrid snake present throughout Russia and Asia. Its venom induces life-threatening hemorrhagic symptoms and severe disseminated intravascular coagulation with a fibrinolytic phenotype. R. tigrinus antivenom manufactured by the immunization of horses to neutralize the venom has the risk of adverse events such as anaphylaxis and serum sickness disease. It should be used when benefit is greater than the risk of adverse effects; however, its efficacy has not been well evaluated. Although our previous survey of nine cases demonstrated that seven of all cases treated with antivenom survived, the clinical characteristics and prognosis without antivenom administration remained unclear. We assumed that R. tigrinus antivenom administration overlaps self-recovery with supportive care. We aimed to determine the association between antivenom administration and outcome with further analyzed cases. METHODS We retrospectively reviewed the records of the Japan Snake Institute between January 1, 1973 and December 31, 2013. Antivenom and without antivenom groups were compared with regard to baseline demographic features, treatment-related factors, and outcomes. RESULTS In total, 34 patients were analyzed (97% male, median age 37.5 years). Twenty-five patients were further examined from our previous study. On admission, the median levels of fibrinogen and fibrinogen degradation products were 35 mg/dL and 200 μg/mL, respectively, and platelet counts were 107,000/mm(3). The median disseminated intravascular coagulation score (defined by the Japanese Association of Acute Medicine) was 5. Antivenom was administered to 19 patients, with a median interval of 32 h between bite and antivenom administration. The in-hospital mortality rate was 12%. In univariate analysis, baseline characteristics and laboratory data were not significantly different between the antivenom and without antivenom groups. Hospital mortality in the antivenom group was significantly better than that in the without antivenom group (0% vs. 26.7%, P = 0.03). Moreover, the number of patients developing renal failure requiring hemodialysis was significantly lower in the antivenom group (5.3% vs. 40.0%, P = 0.03). CONCLUSIONS In our small retrospective study, antivenom administration was likely to be effective in the management of R. tigrinus bites. Apparently, further research is required to confirm its efficacy.
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Affiliation(s)
- Toru Hifumi
- Emergency Medical Center, Kagawa University Hospital, 1750-1 Ikenobe, Miki Kita, Kagawa 761-0793 Japan
| | - Atsushi Sakai
- The Japan Snake Institute, Yabutsuka 3318, Ota Gumma, 379-2301 Japan
| | - Akihiko Yamamoto
- Department of Bacteriology II, National Institute of Infectious Disease, Gakuen 4-7-1, Musashimurayama-shi, Tokyo 208-0011 Japan
| | - Masahiro Murakawa
- Department of Internal Medicine, Kaizuka Hospital, Hakosaki 7-7-27, Higashi-ku, Fukuoka 812-0053 Japan
| | - Manabu Ato
- Department of Immunology, National Institute of Infectious Disease, Toyama 1-23-1, Shinjuku-ku, Tokyo 162-8640 Japan
| | - Keigo Shibayama
- Department of Bacteriology II, National Institute of Infectious Disease, Gakuen 4-7-1, Musashimurayama-shi, Tokyo 208-0011 Japan
| | - Hiroshi Kato
- Division of Critical Care Medicine and Trauma, National Hospital Organization Disaster Medical Center, 3256 Midori-cho, Tachikawa, Tokyo 190-0014 Japan
| | - Yuichi Koido
- Division of Critical Care Medicine and Trauma, National Hospital Organization Disaster Medical Center, 3256 Midori-cho, Tachikawa, Tokyo 190-0014 Japan
| | - Junichi Inoue
- Division of Critical Care Medicine and Trauma, Yamanashi Prefectural Central Hospital, 1-1-1 Fujimicho, Kofu, Yamanashi 400-8506 Japan
| | - Yuko Abe
- Emergency Medical Center, Kagawa University Hospital, 1750-1 Ikenobe, Miki Kita, Kagawa 761-0793 Japan
| | - Kenya Kawakita
- Emergency Medical Center, Kagawa University Hospital, 1750-1 Ikenobe, Miki Kita, Kagawa 761-0793 Japan
| | - Masanobu Hagiike
- Emergency Medical Center, Kagawa University Hospital, 1750-1 Ikenobe, Miki Kita, Kagawa 761-0793 Japan
| | - Akihiko Ginnaga
- The Chemo-Sero-Therapeutic Research Institute (KAKETSUKEN), 1-6-1 Okubo, Kita-ku, Kumamoto-shi, Kumamoto 860-8568 Japan
| | - Yasuhiro Kuroda
- Emergency Medical Center, Kagawa University Hospital, 1750-1 Ikenobe, Miki Kita, Kagawa 761-0793 Japan
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12221
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Hamaya H, Hifumi T, Kawakita K, Okazaki T, Kiridume K, Shinohara N, Abe Y, Takano K, Hagiike M, Kuroda Y. Successful management of heat stroke associated with multiple-organ dysfunction by active intravascular cooling. Am J Emerg Med 2014; 33:124.e5-7. [PMID: 25027198 DOI: 10.1016/j.ajem.2014.05.056] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2014] [Revised: 05/26/2014] [Accepted: 05/28/2014] [Indexed: 11/25/2022] Open
Abstract
Heat stroke is a life-threatening condition requiring immediate initiation of rapid and effective cooling. We report successful cooling with initial intravascular cooling use that rapidly achieved the target temperature with continued normothermia thereafter. A 39-year-old previously healthy man collapsed on a hot, humid day and presented with a disturbance of consciousness. On initial examination, Glasgow Coma Scale score was 6/15, and his body temperature was 40.7°C. He was therefore intubated, and fluid resuscitation was initiated. A Cool Line catheter (Asahi KASEI ZOLL Medical, Tokyo, Japan) was inserted, and aggressive cooling was started using the intravascular balloon-catheter system (The Thermogard XP system; Asahi KASEI ZOLL Medical) within 32 minutes of arrival. His core temperature reached 38.8°C after 17 minutes of intravascular cooling at an average cooling rate of 0.10°C/min. Further investigation revealed impaired liver function and renal failure. His hemodynamic condition was stabilized, and no vasoactive agents were administrated during hospitalization. The cooling catheter was removed on day 2 of admission, and no bleeding, infection, or thrombosis associated with catheter placement was observed. Blood and urine cultures remained negative. Extubation was performed on day 3, and he was discharged on day 5 without further complication or sequelae. It is essential in the treatment of heat stroke to cool as quickly as possible and to provide cardiovascular support. In patients with severe heat stroke and multiple-organ dysfunction, initial use of the active intravascular cooling technique is warranted for aggressive cooling.
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Affiliation(s)
- Hideyuki Hamaya
- Emergency Medical Center, Kagawa University Hospital, Kagawa, 761-0793, Japan.
| | - Toru Hifumi
- Emergency Medical Center, Kagawa University Hospital, Kagawa, 761-0793, Japan.
| | - Kenya Kawakita
- Emergency Medical Center, Kagawa University Hospital, Kagawa, 761-0793, Japan.
| | - Tomoya Okazaki
- Emergency Medical Center, Kagawa University Hospital, Kagawa, 761-0793, Japan.
| | - Kazutaka Kiridume
- Emergency Medical Center, Kagawa University Hospital, Kagawa, 761-0793, Japan.
| | - Natsuyo Shinohara
- Emergency Medical Center, Kagawa University Hospital, Kagawa, 761-0793, Japan.
| | - Yuko Abe
- Emergency Medical Center, Kagawa University Hospital, Kagawa, 761-0793, Japan.
| | - Koshiro Takano
- Emergency Medical Center, Kagawa University Hospital, Kagawa, 761-0793, Japan.
| | - Masanobu Hagiike
- Emergency Medical Center, Kagawa University Hospital, Kagawa, 761-0793, Japan.
| | - Yasuhiro Kuroda
- Emergency Medical Center, Kagawa University Hospital, Kagawa, 761-0793, Japan.
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12222
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Asai S, Motoyama A, Matsumoto Y, Konami H, Imanaka H, Nishimura M. Decrease in cuff pressure during the measurement procedure: an experimental study. J Intensive Care 2014; 2:34. [PMID: 25908987 PMCID: PMC4407310 DOI: 10.1186/2052-0492-2-34] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2014] [Accepted: 05/14/2014] [Indexed: 12/03/2022] Open
Abstract
Background To prevent endotracheal tube (ETT)-related complications during mechanical ventilation, ETT cuff pressure should be kept within proper range. In clinical settings, cuff pressure often decreases from target values. Methods We performed an experimental study to investigate the effects of measuring devices and endotracheal tubes on change in cuff pressure. We continuously measured cuff pressure by inserting a three-way stopcock in the middle of an ETT pilot balloon system. After adjusting the cuff pressure to 24 cmH2O, we disconnected and reconnected each cuff inflator to the inflation valve of the ETT and measured the changes in the cuff pressure. We measured the change in cuff pressure with different ETT sizes, cuff shapes, brands of cuff inflator, and with and without added extension tubes. Results The cuff pressure decreased, on average, by 6.6 cmH2O (standard deviation 1.9), when connecting the cuff inflator to the pilot balloon. The measured cuff pressure was less than 20 cmH2O in 67% of the tests. The cuff pressure decreased more when an extension tube was used. The brand of cuff inflator made no difference to the pressure loss. The cuff pressure decreased more with ETTs of smaller size and with ETTs with pyriform cuffs. Conclusions Procedures to connect cuff inflators to inflation valves resulted in the loss of cuff pressure by 6.6 cmH2O on average.
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Affiliation(s)
- Shota Asai
- The University of Tokushima Graduate School, Tokushima, 770-0855 Japan
| | - Asuka Motoyama
- The University of Tokushima Graduate School, Tokushima, 770-0855 Japan
| | - Yuri Matsumoto
- The University of Tokushima Graduate School, Tokushima, 770-0855 Japan
| | - Hiroyuki Konami
- The University of Tokushima Graduate School, Tokushima, 770-0855 Japan
| | - Hideaki Imanaka
- Emergency and Disaster Medicine, Tokushima University Hospital, Tokushima, 770-8503 Japan
| | - Masaji Nishimura
- Emergency and Critical Care Medicine, Tokushima University Hospital, Tokushima, 770-8503 Japan
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12223
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Pathophysiology and biomarkers of acute respiratory distress syndrome. J Intensive Care 2014; 2:32. [PMID: 25520844 PMCID: PMC4267590 DOI: 10.1186/2052-0492-2-32] [Citation(s) in RCA: 65] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2014] [Accepted: 04/24/2014] [Indexed: 01/28/2023] Open
Abstract
Acute respiratory distress syndrome (ARDS) is defined as an acute-onset, progressive, hypoxic condition with radiographic bilateral lung infiltration, which develops after several diseases or injuries, and is not derived from hydrostatic pulmonary edema. One specific pathological finding of ARDS is diffuse alveolar damage. In 2012, in an effort to increase diagnostic specificity, a revised definition of ARDS was published in JAMA. However, no new parameters or biomarkers were adopted by the revised definition. Discriminating between ARDS and other similar diseases is critically important; however, only a few biomarkers are currently available for diagnostic purposes. Furthermore, predicting the severity, response to therapy, or outcome of the illness is also important for developing treatment strategies for each patient. However, the PaO2/FIO2 ratio is currently the sole clinical parameter used for this purpose. In parallel with progress in understanding the pathophysiology of ARDS, various humoral factors induced by inflammation and molecules derived from activated cells or injured tissues have been shown as potential biomarkers that may be applied in clinical practice. In this review, the current understanding of the basic pathophysiology of ARDS and associated candidate biomarkers will be discussed.
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Hifumi T, Kato H, Koido Y, Kawakita K, Kuroda Y. Safety and effective use of landiolol in the ICU. J Intensive Care 2014; 2:16. [PMID: 25520832 PMCID: PMC4267602 DOI: 10.1186/2052-0492-2-16] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2014] [Accepted: 02/19/2014] [Indexed: 11/16/2022] Open
Abstract
Supplemental landiolol administration (20 or 40 μg kg-1 min-1) effectively diminished harmful hemodynamic changes during bronchoscopic endotracheal suctioning compared to normal saline. However, inappropriate use of landiolol (i.e., failure of evaluating factors that influence hemodynamic changes) may iatrogenically further complicate pathophysiology, and relatively higher doses of landiolol may be dangerous. We recommend that landiolol should not be routinely used to control cardiovascular responses during bronchoscopic endotracheal suctioning in the intensive care unit. Careful evaluation of factors influencing hemodynamic changes and close monitoring of the patient are mandatory following landiolol administration. Furthermore, a lower initiation dose is recommended.
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Affiliation(s)
- Toru Hifumi
- Division of Critical Care Medicine and Trauma, National Hospital Organization Disaster Medical Center, 3256 Midori-cho, Tachikawa, Tokyo, 190-0014 Japan
| | - Hiroshi Kato
- Division of Critical Care Medicine and Trauma, National Hospital Organization Disaster Medical Center, 3256 Midori-cho, Tachikawa, Tokyo, 190-0014 Japan
| | - Yuichi Koido
- Division of Critical Care Medicine and Trauma, National Hospital Organization Disaster Medical Center, 3256 Midori-cho, Tachikawa, Tokyo, 190-0014 Japan
| | - Kenya Kawakita
- Division of Critical Care Medicine and Trauma, National Hospital Organization Disaster Medical Center, 3256 Midori-cho, Tachikawa, Tokyo, 190-0014 Japan
| | - Yasuhiro Kuroda
- Division of Critical Care Medicine and Trauma, National Hospital Organization Disaster Medical Center, 3256 Midori-cho, Tachikawa, Tokyo, 190-0014 Japan
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Chikata Y, Izawa M, Imanaka H, Okuda N, Nishimura M. Correction: Temperature of gas delivered from ventilators. J Intensive Care 2013; 1:16. [PMID: 25960876 PMCID: PMC4424707 DOI: 10.1186/2052-0492-1-16] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2013] [Accepted: 12/05/2013] [Indexed: 11/10/2022] Open
Affiliation(s)
- Yusuke Chikata
- Emergency and Critical Care Medicine, The University of Tokushima Graduate School, 3-18-15 Kuramoto, Tokushima City 770-8503, Japan ; Medical Equipment Center, Tokushima University Hospital, 2-50-1 Kuramoto, Tokushima City 770-8503, Japan
| | - Masayo Izawa
- Emergency and Critical Care Medicine, The University of Tokushima Graduate School, 3-18-15 Kuramoto, Tokushima City 770-8503, Japan
| | - Hideaki Imanaka
- Emergency and Disaster Medicine, Tokushima University Hospital, 2-50-1 Kuramoto, Tokushima City 770-8503, Japan
| | - Nao Okuda
- Emergency and Critical Care Medicine, The University of Tokushima Graduate School, 3-18-15 Kuramoto, Tokushima City 770-8503, Japan
| | - Masaji Nishimura
- Emergency and Critical Care Medicine, The University of Tokushima Graduate School, 3-18-15 Kuramoto, Tokushima City 770-8503, Japan
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