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Kajino K, Daya MR, Onoe A, Nakamura F, Nakajima M, Sakuramoto K, Ong MEH, Kuwagata Y. Development and validation of a prehospital termination of resuscitation (TOR) rule for out - of hospital cardiac arrest (OHCA) cases using general purpose artificial intelligence (AI). Resuscitation 2024; 197:110165. [PMID: 38452995 DOI: 10.1016/j.resuscitation.2024.110165] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2024] [Revised: 02/27/2024] [Accepted: 02/28/2024] [Indexed: 03/09/2024]
Abstract
BACKGROUND Prehospital identification of futile resuscitation efforts (defined as a predicted probability of survival lower than 1%) for out-of-hospital cardiac arrest (OHCA) may reduce unnecessary transport. Reliable prediction variables for OHCA 'termination of resuscitation' (TOR) rules are needed to guide treatment decisions. The Universal TOR rule uses only three variables (Absence of Prehospital ROSC, Event not witnessed by EMS and no shock delivered on the scene) has been externally validated and is used by many EMS systems. Deep learning, an artificial intelligence (AI) platform is an attractive model to guide the development of TOR rule for OHCA. The purpose of this study was to assess the feasibility of developing an AI-TOR rule for neurologically favorable outcomes using general purpose AI and compare its performance to the Universal TOR rule. METHODS We identified OHCA cases of presumed cardiac etiology who were 18 years of age or older from 2016 to 2019 in the All-Japan Utstein Registry. We divided the dataset into 2 parts, the first half (2016-2017) was used as a training dataset for rule development and second half (2018-2019) for validation. The AI software (Prediction One®) created the model using the training dataset with internal cross-validation. It also evaluated the prediction accuracy and displayed the ranking of influencing variables. We performed validation using the second half cases and calculated the prediction model AUC. The top four of the 11 variables identified in the model were then selected as prognostic factors to be used in an AI-TOR rule, and sensitivity, specificity, positive predictive value, and negative predictive value were calculated from validation cohort. This was then compared to the performance of the Universal TOR rule using same dataset. RESULTS There were 504,561 OHCA cases, 18 years of age or older, 302,799 cases were presumed cardiac origin. Of these, 149,425 cases were used for the training dataset and 153,374 cases for the validation dataset. The model developed by AI using 11 variables had an AUC of 0.969, and its AUC for the validation dataset was 0.965. The top four influencing variables for neurologically favorable outcome were Prehospital ROSC, witnessed by EMS, Age (68 years old and younger) and nonasystole. The AUC calculated using the 4 variables for the AI-TOR rule was 0.953, and its AUC for the validation dataset was 0.952 (95%CI 0.949 -0.954). Of 80,198 patients in the validation cohort that satisfied all four criteria for the AI-TOR rule, 58 (0.07%) had a neurologically favorable one-month survival. The specificity of AI-TOR rule was 0.990, and the PPV was 0.999 for predicting lack of neurologically favorable survival, both the specificity and PPV were higher than that achieved with the universal TOR (0.959, 0.998). CONCLUSIONS The accuracy of prediction models using AI software to determine outcomes in OHCA was excellent and the AI-TOR rule's variables from prediction model performed better than the Universal TOR rule. External validation of our findings as well as further research into the utility of using AI platforms for TOR prediction in clinical practice is needed.
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Affiliation(s)
- Kentaro Kajino
- Department of Emergency and Critical Care Medicine, Kansai Medical University, Hirakata, Osaka, Japan.
| | - Mohamud R Daya
- Department of Emergency Medicine, Oregon Health & Science University, Portland, OR, USA
| | - Atsunori Onoe
- Department of Emergency and Critical Care Medicine, Kansai Medical University, Hirakata, Osaka, Japan
| | - Fumiko Nakamura
- Department of Emergency and Critical Care Medicine, Kansai Medical University, Hirakata, Osaka, Japan
| | - Mari Nakajima
- Department of Emergency and Critical Care Medicine, Kansai Medical University, Hirakata, Osaka, Japan
| | - Kazuhito Sakuramoto
- Department of Emergency and Critical Care Medicine, Kansai Medical University, Hirakata, Osaka, Japan
| | - Marcus Eng Hock Ong
- Department of Emergency Medicine, Singapore General Hospital, Singapore; Health Services and Systems Research, Duke-NUS Medical School, Singapore
| | - Yasuyuki Kuwagata
- Department of Emergency and Critical Care Medicine, Kansai Medical University, Hirakata, Osaka, Japan
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Sakuramoto K, Wada D, Maruyama S, Muroya T, Saito F, Nakamori Y, Kuwagata Y. Evaluation of characteristics and prognosis of COVID-19 patients requiring invasive mechanical ventilation during dominance of nonvariant, alpha, delta, and omicron variants in tertiary hospitals of Japan. BMC Infect Dis 2024; 24:223. [PMID: 38374034 PMCID: PMC10877910 DOI: 10.1186/s12879-024-09131-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2023] [Accepted: 02/13/2024] [Indexed: 02/21/2024] Open
Abstract
BACKGROUND In November 2021, the B.1.1.529 (omicron) variant of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) was detected in South Africa and subsequently rapidly spread around the world. Despite the reduced severity of the omicron variants, many patients become severely ill after infection and undergo invasive mechanical ventilation, but there are few reports on their background and prognosis throughout all variant periods. This study aimed to evaluate risk factors affecting patients requiring invasive mechanical ventilation with each variant of COVID-19 pandemic in Japan from nonvariants to omicron variants. METHOD This retrospective observational study was conducted at the Department of Emergency and Critical Care Medicine, Kansai Medical University Hospital and Kansai Medical University Medical Center, Osaka, Japan, from March 2020 to March 2023. Eligible patients were those who underwent invasive ventilation for COVID-19 pneumonia. We set the primary endpoint as in-hospital mortality. Multivariable logistic regression analysis adjusted for clinically important variables was performed to evaluate the clinical outcomes. RESULTS We included 377 patients: 118 in the Nonvariant group, 154 in the Alpha group, 42 in the Delta group, and 63 patients in the Omicron group. Mortality rates for each group were 23.7% for the Nonvariant group, 12.3% for the Alpha group, 7.1% for the Delta group, and 30.5% for the Omicron group. Patient age was significantly associated with increased mortality (adjusted odds ratio [AOR]: 1.097; 95% confidence interval [CI]: 1.057-0.138, P < 0.001). Immunodeficiency (AOR: 3.388, 95% CI: 1.377-8.333, P = 0.008), initial SOFA score (AOR: 1.190, 95% CI: 1.056-1.341, P = 0.004), dialysis prior to COVID-19 (AOR: 3.695, 95% CI: 1.117-11.663, P = 0.026), and smoking history (AOR: 2.548, 95% CI: 1.153-5.628, P = 0.021) were significantly associated with increased mortality. Differences in variants were not significant factors associated with high mortality. CONCLUSION We compared the background and prognosis of patients with COVID-19 pneumonia requiring invasive mechanical ventilation between SARS-CoV-2 variants. In these patients, differences in variants did not affect prognosis. Hospital mortality in critically ill COVID-19 patients was significantly higher in the older patients with bacterial coinfection, or patients with immunodeficiency, COPD, and chronic renal failure on dialysis.
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Affiliation(s)
- Kazuhito Sakuramoto
- Department of Emergency and Critical Care Medicine, Kansai Medical University Hospital, 2-3-1 Shinmachi, Hirakata, Osaka, 573-1191, Japan
| | - Daiki Wada
- Department of Emergency and Critical Care Medicine, Kansai Medical University General Medical Center, 10-15 Fumizono-cho, Moriguchi, Osaka, 570-8507, Japan.
| | - Shuhei Maruyama
- Department of Emergency and Critical Care Medicine, Kansai Medical University General Medical Center, 10-15 Fumizono-cho, Moriguchi, Osaka, 570-8507, Japan
| | - Takashi Muroya
- Department of Emergency and Critical Care Medicine, Kansai Medical University Hospital, 2-3-1 Shinmachi, Hirakata, Osaka, 573-1191, Japan
| | - Fukuki Saito
- Department of Emergency and Critical Care Medicine, Kansai Medical University General Medical Center, 10-15 Fumizono-cho, Moriguchi, Osaka, 570-8507, Japan
| | - Yasushi Nakamori
- Department of Emergency and Critical Care Medicine, Kansai Medical University General Medical Center, 10-15 Fumizono-cho, Moriguchi, Osaka, 570-8507, Japan
| | - Yasuyuki Kuwagata
- Department of Emergency and Critical Care Medicine, Kansai Medical University Hospital, 2-3-1 Shinmachi, Hirakata, Osaka, 573-1191, Japan
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Maruyama S, Wada D, Yoshihara T, Saito F, Yoshiya K, Nakamori Y, Kuwagata Y. Treatment strategy for severe trauma patients requiring aortic occlusion for impending cardiopulmonary arrest in the hybrid emergency room. Acute Med Surg 2024; 11:e928. [PMID: 38293705 PMCID: PMC10825068 DOI: 10.1002/ams2.928] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2023] [Revised: 01/14/2024] [Accepted: 01/17/2024] [Indexed: 02/01/2024] Open
Abstract
Aim Computed tomography (CT) is useful in trauma care. Severely ill trauma patients may not tolerate whole-body CT even without patient transfer. This study examined clinical flow of severe trauma patients requiring aortic occlusion (AO) such as resuscitative thoracotomy or REBOA in the hybrid emergency room (ER) and investigated patient clinical courses prioritizing CT first versus resuscitation including AO first. Methods This retrospective, single-center observational study included consecutive trauma patients visiting our ER between May 2016 and February 2023. Patients were divided into the CT first group (whole-body CT preceded AO) and AO first group (AO preceded whole-body CT) and into two subgroups: AO after CT (AO/interventions for hemorrhage performed just after CT in the CT first group), and CT after AO (CT or damage control surgery performed after AO in the AO first group). We investigated 28-day survival rates. Results Survival probability by TRISS method was 49% (range: 3.3-94) in the CT first group (n = 6) and 20% (range: 0.7-45) in the AO first group (n = 7). Actual 28-day survival rates were 50% and 57%, respectively. Survival rates of the AO after CT subgroup (CT first group) were 75% (3/4) and 0% (0/2), respectively, and those of the CT after AO subgroup (AO first group) were 25% (1/4) and 100% (3/3), respectively. Conclusion In severe trauma patients with low predicted probability of survival treated in the hybrid ER, survival rates might be better if resuscitation including AO is performed before CT and if damage control surgery is performed first before CT.
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Affiliation(s)
- Shuhei Maruyama
- Department of Emergency and Critical Care MedicineKansai Medical University Medical CenterOsakaJapan
| | - Daiki Wada
- Department of Emergency and Critical Care MedicineKansai Medical University Medical CenterOsakaJapan
| | - Tomoyuki Yoshihara
- Department of Emergency and Critical Care MedicineKansai Medical University Medical CenterOsakaJapan
| | - Fukuki Saito
- Department of Emergency and Critical Care MedicineKansai Medical University Medical CenterOsakaJapan
| | - Kazuhisa Yoshiya
- Department of Emergency and Critical Care MedicineKansai Medical University Medical CenterOsakaJapan
| | - Yasushi Nakamori
- Department of Emergency and Critical Care MedicineKansai Medical University Medical CenterOsakaJapan
| | - Yasuyuki Kuwagata
- Department of Emergency and Critical Care MedicineKansai Medical University HospitalOsakaJapan
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Shimazu H, Wada D, Maruyama S, Inoue A, Kashihara M, Yoshihara T, Saito F, Yoshiya K, Nakamori Y, Kuwagata Y. Clinical experience of treatment of immunocompromised individuals with persistent SARS-CoV-2 infection based on drug resistance mutations determined by genomic analysis: a descriptive study. BMC Infect Dis 2023; 23:780. [PMID: 37946111 PMCID: PMC10636837 DOI: 10.1186/s12879-023-08797-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Accepted: 11/06/2023] [Indexed: 11/12/2023] Open
Abstract
BACKGROUND The efficacy of antiviral drugs that neutralize antibody drugs and fight against SARS-COV-2 is reported to be attenuated by genetic mutations of the virus in vitro. When B-cell immunocompromised patients are infected with SARS-COV-2, the infection can be prolonged, and genetic mutations can occur during the course of treatment. Therefore, for refractory patients with persistent COVID-19 infection, genomic analysis was performed to obtain data on drug resistance mutations as a reference to determine which antiviral drugs and antibody therapies might be effective in their treatment. METHODS This was a descriptive analysis with no controls. Patients were diagnosed as having COVID-19, examined, and treated in the Kansai Medical University General Medical Center between January 2022 and January 2023. The subjects of the study were B-cell immunocompromised patients in whom genome analysis of SARS-CoV-2 was performed. RESULTS During the study period, 984 patients with COVID-19 were treated at our hospital. Of those, 17 refractory cases underwent genomic analysis. All 17 patients had factors related to immunodeficiency, such as malignant lymphoma or post-organ transplantation. Eleven patients started initial treatment for COVID-19 at our hospital, developed persistent infection, and underwent genomic analysis. Six patients who were initially treated for COVID-19 at other hospitals became persistently infected and were transferred to our hospital. Before COVID-19 treatment, genomic analysis showed no intrahost mutations in the NSP5, the NSP12, and the RBD regions. After COVID-19 treatment, mutations in these regions were found in 12 of 17 cases (71%). Sixteen patients survived the quarantine, but one died of sepsis. CONCLUSIONS In genomic analysis, more mutations were found to be drug-resistant after COVID-19 treatment than before COVID-19 treatment. Although it was not possible to demonstrate the usefulness of genome analysis for clinical application, the change of the treatment drug with reference to drug resistance indicated by genomic analysis may lead to good outcome of immunocompromised COVID-19 patients.
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Affiliation(s)
- Haruka Shimazu
- Department of Emergency and Critical Care Medicine, Kansai Medical University General Medical Center, 10-15 Fumizono-Cho, Moriguchi, Osaka, 570-8507, Japan
| | - Daiki Wada
- Department of Emergency and Critical Care Medicine, Kansai Medical University General Medical Center, 10-15 Fumizono-Cho, Moriguchi, Osaka, 570-8507, Japan.
| | - Shuhei Maruyama
- Department of Emergency and Critical Care Medicine, Kansai Medical University General Medical Center, 10-15 Fumizono-Cho, Moriguchi, Osaka, 570-8507, Japan
| | - Akira Inoue
- Department of Emergency and Critical Care Medicine, Kansai Medical University General Medical Center, 10-15 Fumizono-Cho, Moriguchi, Osaka, 570-8507, Japan
| | - Masami Kashihara
- Department of Emergency and Critical Care Medicine, Kansai Medical University General Medical Center, 10-15 Fumizono-Cho, Moriguchi, Osaka, 570-8507, Japan
| | - Tomoyuki Yoshihara
- Department of Emergency and Critical Care Medicine, Kansai Medical University General Medical Center, 10-15 Fumizono-Cho, Moriguchi, Osaka, 570-8507, Japan
| | - Fukuki Saito
- Department of Emergency and Critical Care Medicine, Kansai Medical University General Medical Center, 10-15 Fumizono-Cho, Moriguchi, Osaka, 570-8507, Japan
| | - Kazuhisa Yoshiya
- Department of Emergency and Critical Care Medicine, Kansai Medical University General Medical Center, 10-15 Fumizono-Cho, Moriguchi, Osaka, 570-8507, Japan
| | - Yasushi Nakamori
- Department of Emergency and Critical Care Medicine, Kansai Medical University General Medical Center, 10-15 Fumizono-Cho, Moriguchi, Osaka, 570-8507, Japan
| | - Yasuyuki Kuwagata
- Department of Emergency and Critical Care Medicine, Kansai Medical University Hospital, 2-3-1 Shinmachi, Hirakata, Osaka, 573-1191, Japan
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Onoe A, Muroya T, Nakamura Y, Nakamura F, Yagura T, Nakajima M, Kishimoto M, Sakuramoto K, Kajino K, Ikegawa H, Kuwagata Y. Efficacy of the shoelace technique for extremity fasciotomy wounds due to compartment syndrome. BMC Musculoskelet Disord 2023; 24:704. [PMID: 37667241 PMCID: PMC10476399 DOI: 10.1186/s12891-023-06849-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Accepted: 08/31/2023] [Indexed: 09/06/2023] Open
Abstract
BACKGROUND The shoelace technique for compartment syndrome allows application of sustained tightening tension to an entire wound and intermittent tightening of the shoelace without requiring its replacement or anesthesia. We retrospectively evaluated the usefulness of the shoelace technique in the management of extremity fasciotomy wounds before and after its introduction in our institution. METHODS We targeted 25 patients who were diagnosed as having compartment syndrome and underwent extremity fasciotomy at our hospital from April 2012 to December 2021. The N group, comprising 12 patients treated without the shoelace technique, and the S group, comprising 13 patients treated with the shoelace technique, were compared retrospectively for each outcome. RESULTS There were no significant differences between the two groups in patient background. Compared with the N group patients, all of the S group patients avoided skin grafting (S group: n = 0, 0%; N group: n = 6, 50.0%; p < 0.01). However, there was no significant difference in the number of days to final wound closure (S group: 39.5 [IQR 24.3-58.0] days; N group: 24.0 [IQR 18.5-31.0] days, p = 0.06). CONCLUSIONS We considered the shoelace technique to be a useful wound closure method for fasciotomy wounds caused by compartment syndrome because it can significantly reduce the need for skin grafting and tends to shorten the wound closure period.
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Affiliation(s)
- Atsunori Onoe
- Department of Emergency and Critical Care Medicine, Kansai Medical University, Hirakata, Osaka, Japan, 573-1010.
| | - Takashi Muroya
- Department of Emergency and Critical Care Medicine, Kansai Medical University, Hirakata, Osaka, Japan, 573-1010
| | - Yoshihiro Nakamura
- Department of Emergency and Critical Care Medicine, Kansai Medical University, Hirakata, Osaka, Japan, 573-1010
| | - Fumiko Nakamura
- Department of Emergency and Critical Care Medicine, Kansai Medical University, Hirakata, Osaka, Japan, 573-1010
| | - Takuma Yagura
- Department of Orthopaedic Surgery, Kansai Medical University, Hirakata, Osaka, Japan
| | - Mari Nakajima
- Department of Emergency and Critical Care Medicine, Kansai Medical University, Hirakata, Osaka, Japan, 573-1010
| | - Masanobu Kishimoto
- Department of Emergency and Critical Care Medicine, Kansai Medical University, Hirakata, Osaka, Japan, 573-1010
| | - Kazuhito Sakuramoto
- Department of Emergency and Critical Care Medicine, Kansai Medical University, Hirakata, Osaka, Japan, 573-1010
| | - Kentaro Kajino
- Department of Emergency and Critical Care Medicine, Kansai Medical University, Hirakata, Osaka, Japan, 573-1010
| | - Hitoshi Ikegawa
- Department of Emergency and Critical Care Medicine, Kansai Medical University, Hirakata, Osaka, Japan, 573-1010
| | - Yasuyuki Kuwagata
- Department of Emergency and Critical Care Medicine, Kansai Medical University, Hirakata, Osaka, Japan, 573-1010
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Maruyama S, Wada D, Oishi T, Saito F, Yoshiya K, Nakamori Y, Kuwagata Y. A descriptive study of abdominal complications in patients with mild COVID-19 presenting to the emergency department: a single-center experience in Japan during the omicron variant phase. BMC Gastroenterol 2023; 23:43. [PMID: 36800938 PMCID: PMC9938954 DOI: 10.1186/s12876-023-02681-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2022] [Accepted: 02/15/2023] [Indexed: 02/21/2023] Open
Abstract
BACKGROUND COVID-19 is widely known to induce a variety of extrapulmonary manifestations. Gastrointestinal symptoms have been identified as the most common extra-pulmonary manifestations of COVID-19, with an incidence reported to range from 3 to 61%. Although previous reports have addressed abdominal complications with COVID-19, these have not been adequately elucidated for the omicron variant. The aim of our study was to clarify the diagnosis of concomitant abdominal diseases in patients with mild COVID-19 who presented to hospital with abdominal symptoms during the sixth and seventh waves of the pandemic of the omicron variant in Japan. METHODS This study was a retrospective, single-center, descriptive study. In total, 2291 consecutive patients with COVID-19 who visited the Department of Emergency and Critical Care Medicine, Kansai Medical University Medical Center, Osaka, Japan, between January 2022 and September 2022 were potentially eligible for the study. Patients delivered by ambulance or transferred from other hospitals were not included. We collected and described physical examination results, medical history, laboratory data, computed tomography findings and treatments. Data collected included diagnostic characteristics, abdominal symptoms, extra-abdominal symptoms and complicated diagnosis other than that of COVID-19 for abdominal symptoms. RESULTS Abdominal symptoms were present in 183 patients with COVID-19. The number of patients with each abdominal symptom were as follows: nausea and vomiting (86/183, 47%), abdominal pain (63/183, 34%), diarrhea (61/183, 33%), gastrointestinal bleeding (20/183, 11%) and anorexia (6/183, 3.3%). Of these patients, 17 were diagnosed as having acute hemorrhagic colitis, five had drug-induced adverse events, two had retroperitoneal hemorrhage, two had appendicitis, two had choledocholithiasis, two had constipation, and two had anuresis, among others. The localization of acute hemorrhagic colitis was the left-sided colon in all cases. CONCLUSIONS Our study showed that acute hemorrhagic colitis was characteristic in mild cases of the omicron variant of COVID-19 with gastrointestinal bleeding. When examining patients with mild COVID-19 with gastrointestinal bleeding, the potential for acute hemorrhagic colitis should be kept in mind.
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Affiliation(s)
- Shuhei Maruyama
- Department of Emergency and Critical Care Medicine, Kansai Medical University Medical Center, 10-15 Fumizono-cho, Moriguchi, Osaka, 570-8507, Japan.
| | - Daiki Wada
- grid.410783.90000 0001 2172 5041Department of Emergency and Critical Care Medicine, Kansai Medical University Medical Center, 10-15 Fumizono-cho, Moriguchi, Osaka 570-8507 Japan
| | - Takahiro Oishi
- grid.410783.90000 0001 2172 5041Department of Emergency and Critical Care Medicine, Kansai Medical University Medical Center, 10-15 Fumizono-cho, Moriguchi, Osaka 570-8507 Japan
| | - Fukuki Saito
- grid.410783.90000 0001 2172 5041Department of Emergency and Critical Care Medicine, Kansai Medical University Medical Center, 10-15 Fumizono-cho, Moriguchi, Osaka 570-8507 Japan
| | - Kazuhisa Yoshiya
- grid.410783.90000 0001 2172 5041Department of Emergency and Critical Care Medicine, Kansai Medical University Medical Center, 10-15 Fumizono-cho, Moriguchi, Osaka 570-8507 Japan
| | - Yasushi Nakamori
- grid.410783.90000 0001 2172 5041Department of Emergency and Critical Care Medicine, Kansai Medical University Medical Center, 10-15 Fumizono-cho, Moriguchi, Osaka 570-8507 Japan
| | - Yasuyuki Kuwagata
- grid.410783.90000 0001 2172 5041Department of Emergency and Critical Care Medicine, Kansai Medical University Hospital, 2-3-1 Shinmachi, Hirakata, Osaka 573-1191 Japan
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Onoe A, Kajino K, Daya MR, Nakamura F, Nakajima M, Kishimoto M, Sakuramoto K, Muroya T, Ikegawa H, Hock Ong ME, Kuwagata Y. Improved neurologically favorable survival after OHCA is associated with increased pre-hospital advanced airway management at the prefecture level in Japan. Sci Rep 2022; 12:20498. [PMID: 36443385 PMCID: PMC9705308 DOI: 10.1038/s41598-022-25124-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2022] [Accepted: 11/24/2022] [Indexed: 11/29/2022] Open
Abstract
Out-of-hospital cardiac arrest (OHCA) has high incidence and mortality. The survival benefit of pre-hospital advanced airway management (AAM) for OHCA remains controversial. In Japan, pre-hospital AAM are performed for OHCA by emergency medical services (EMS), however the relationship between resuscitation outcomes and AAM at the prefecture level has not been evaluated. The purpose of this study was to describe the association between AAM and neurologically favorable survival (cerebral performance category (CPC) ≦2) at prefecture level. This was a retrospective, population-based study of adult OHCA patients (≧ 18) from January 1, 2014 to December 31, 2017 in Japan. We excluded patients with EMS witnessed arrests. We also only included patients that had care provided by an ELST with the ability to provided AAM and excluded cases that involved prehospital care delivered by a physician. We categorized OHCA into four quartiles (four group: G1-G4) based on frequency of pre-hospital AAM approach rate by prefecture, which is the smallest geographical classification unit, and evaluated the relationship between frequency of pre-hospital AAM approach rates and CPC ≦ 2 for each quartile. Multivariable logistic regression was used to assess effectiveness of AAM on neurologically favorable survival. Among 493,577 OHCA cases, 403,707 matched our inclusion criteria. The number of CPC ≦ 2 survivors increased from G1 to G4 (p for trend < 0.001). In the adjusted multivariable regression, higher frequency of pre-hospital AAM approach was associated with CPC ≦ 2 (p < 0.001). High prefecture frequency of pre-hospital AAM approach was associated with neurologically favorable survival (CPC ≦ 2) in OHCA.
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Affiliation(s)
- Atsunori Onoe
- grid.410783.90000 0001 2172 5041Department of Emergency and Critical Care Medicine, Kansai Medical University, Shinmachi 2-5-1, Hirakata, Osaka 573-1010 Japan
| | - Kentaro Kajino
- grid.410783.90000 0001 2172 5041Department of Emergency and Critical Care Medicine, Kansai Medical University, Shinmachi 2-5-1, Hirakata, Osaka 573-1010 Japan
| | - Mohamud R. Daya
- grid.5288.70000 0000 9758 5690Department of Emergency Medicine, Oregon Health and Science University, Portland, OR USA
| | - Fumiko Nakamura
- grid.410783.90000 0001 2172 5041Department of Emergency and Critical Care Medicine, Kansai Medical University, Shinmachi 2-5-1, Hirakata, Osaka 573-1010 Japan
| | - Mari Nakajima
- grid.410783.90000 0001 2172 5041Department of Emergency and Critical Care Medicine, Kansai Medical University, Shinmachi 2-5-1, Hirakata, Osaka 573-1010 Japan
| | - Masanobu Kishimoto
- grid.410783.90000 0001 2172 5041Department of Emergency and Critical Care Medicine, Kansai Medical University, Shinmachi 2-5-1, Hirakata, Osaka 573-1010 Japan
| | - Kazuhito Sakuramoto
- grid.410783.90000 0001 2172 5041Department of Emergency and Critical Care Medicine, Kansai Medical University, Shinmachi 2-5-1, Hirakata, Osaka 573-1010 Japan
| | - Takashi Muroya
- grid.410783.90000 0001 2172 5041Department of Emergency and Critical Care Medicine, Kansai Medical University, Shinmachi 2-5-1, Hirakata, Osaka 573-1010 Japan
| | - Hitoshi Ikegawa
- grid.410783.90000 0001 2172 5041Department of Emergency and Critical Care Medicine, Kansai Medical University, Shinmachi 2-5-1, Hirakata, Osaka 573-1010 Japan
| | - Marcus Eng Hock Ong
- grid.163555.10000 0000 9486 5048Department of Emergency Medicine, Singapore General Hospital, Singapore, Singapore ,grid.428397.30000 0004 0385 0924Health Services and Systems Research, Duke-NUS Medical School, Singapore, Singapore
| | - Yasuyuki Kuwagata
- grid.410783.90000 0001 2172 5041Department of Emergency and Critical Care Medicine, Kansai Medical University, Shinmachi 2-5-1, Hirakata, Osaka 573-1010 Japan
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Nakamura F, Yui R, Onoe A, Kishimoto M, Sakuramoto K, Muroya T, Kajino K, Ikegawa H, Kuwagata Y. Study of damage control strategy for non-traumatic diseases: a single-center observational study. Eur J Med Res 2022; 27:192. [PMID: 36183102 PMCID: PMC9526978 DOI: 10.1186/s40001-022-00823-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2022] [Accepted: 09/21/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Damage control strategy (DCS) has been introduced not only for trauma but also for acute abdomen, but its indications and usefulness have not been clarified. We examined clinical characteristics of patients who underwent DCS and compared clinical characteristics and results with and without DCS in patients with septic shock. METHODS We targeted a series of endogenous abdominal diseases in Kansai Medical University Hospital from April 2013 to March 2019. Clinical characteristics of 26 patients who underwent DCS were examined. Then, clinical characteristics and results were compared between the DCS group (n = 26) and non-DCS group (n = 31) in 57 patients with septic shock during the same period. RESULTS All 26 patients who underwent DCS had septic shock, low mean arterial pressure (MAP) before the start of surgery, and required high-dose norepinephrine administration intraoperatively. Their discharge mortality rate was 12%. Among the patients with septic shock, the DCS group had a higher SOFA score (P = 0.008) and MAP was lower preoperatively, but it did not increase even with intraoperative administration of large amounts of fluid replacement and vasoconstrictor. There was no significant difference in 28-day mortality and discharge mortality between the two groups. CONCLUSIONS DCS may be useful in patients with severe septic shock.
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Affiliation(s)
- Fumiko Nakamura
- Department of Emergency and Critical Care Medicine, Kansai Medical University, Shinmachi 2-5-1, Hirakata, Osaka, 573-1010, Japan.
| | - Rintaro Yui
- Department of Emergency and Critical Care Medicine, Kansai Medical University, Shinmachi 2-5-1, Hirakata, Osaka, 573-1010, Japan
| | - Atsunori Onoe
- Department of Emergency and Critical Care Medicine, Kansai Medical University, Shinmachi 2-5-1, Hirakata, Osaka, 573-1010, Japan
| | - Masanobu Kishimoto
- Department of Emergency and Critical Care Medicine, Kansai Medical University, Shinmachi 2-5-1, Hirakata, Osaka, 573-1010, Japan
| | - Kazuhito Sakuramoto
- Department of Emergency and Critical Care Medicine, Kansai Medical University, Shinmachi 2-5-1, Hirakata, Osaka, 573-1010, Japan
| | - Takashi Muroya
- Department of Emergency and Critical Care Medicine, Kansai Medical University, Shinmachi 2-5-1, Hirakata, Osaka, 573-1010, Japan
| | - Kentaro Kajino
- Department of Emergency and Critical Care Medicine, Kansai Medical University, Shinmachi 2-5-1, Hirakata, Osaka, 573-1010, Japan
| | - Hitoshi Ikegawa
- Department of Emergency and Critical Care Medicine, Kansai Medical University, Shinmachi 2-5-1, Hirakata, Osaka, 573-1010, Japan
| | - Yasuyuki Kuwagata
- Department of Emergency and Critical Care Medicine, Kansai Medical University, Shinmachi 2-5-1, Hirakata, Osaka, 573-1010, Japan
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9
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Onoe A, Muroya T, Nakamura F, Ikegawa H, Kuwagata Y, Kobayakawa R, Kobayakawa K. EFFECTS OF 2-METHYL-2-THIAZOLINE ON CIRCULATORY DYNAMICS AND INTESTINAL VASCULAR SYSTEM IN RABBITS WITH ENDOTOXIC SHOCK. Shock 2022; 58:341-347. [PMID: 36256628 PMCID: PMC9584048 DOI: 10.1097/shk.0000000000001987] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Accepted: 08/22/2022] [Indexed: 01/24/2023]
Abstract
ABSTRACT We hypothesized that circulatory and jejunal mucosal blood flow would improve after 2-methyl-2thiazoline (2MT) administration in endotoxic shock. This study aimed to evaluate changes in systemic circulation and in superior mesenteric venous (SMV) blood flow and jejunal mucosal tissue blood flow of the intestinal vascular system over time after administration of 2MT in rabbits with endotoxic shock. We created four groups (n = 6 each): control group, LPS (1 mg/kg) group, 2MT (80 mg/kg) group, and LPS-2MT group. As indicators of circulation, we measured MAP, heart rate, cardiac index, lactic acid level, SMV blood flow, and jejunal mucosal tissue blood flow every 30 min from 0 to 240 min. The drop in MAP observed in the LPS group was suppressed by 2MT administration. Superior mesenteric venous blood flow dropped temporarily with LPS administration but then rose thereafter. After administration of 2MT to the LPS group, SMV blood flow began to rise earlier than that in the LPS group and did not decline below that of the control group thereafter. In the LPS group, jejunal mucosal tissue blood flow transiently decreased and then increased but at a lower level than that in the control group. However, in the LPS-2MT group, although a transient decrease in jejunal mucosal tissue blood flow was observed, its flow then improved to the level of the control group. An interaction between 2MT and LPS was observed for jejunal mucosal tissue blood flow from 90 to 180 min and at 240 min (P < 0.05). We showed that 2MT maintained MAP and improved SMV blood flow and jejunal mucosal tissue blood flow. In a rabbit model of endotoxic shock, 2MT had a positive effect on MAP and jejunal mucosal tissue blood flow.
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Affiliation(s)
- Atsunori Onoe
- Department of Emergency and Critical Care Medicine, Kansai Medical University, Osaka, Japan
| | - Takashi Muroya
- Department of Emergency and Critical Care Medicine, Kansai Medical University, Osaka, Japan
| | - Fumiko Nakamura
- Department of Emergency and Critical Care Medicine, Kansai Medical University, Osaka, Japan
| | - Hitoshi Ikegawa
- Department of Emergency and Critical Care Medicine, Kansai Medical University, Osaka, Japan
| | - Yasuyuki Kuwagata
- Department of Emergency and Critical Care Medicine, Kansai Medical University, Osaka, Japan
| | - Reiko Kobayakawa
- Institute of Biomedical Science, Kansai Medical University, Osaka, Japan
| | - Ko Kobayakawa
- Institute of Biomedical Science, Kansai Medical University, Osaka, Japan
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10
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Wada D, Nakamori Y, Maruyama S, Shimazu H, Saito F, Yoshiya K, Kuwagata Y. Novel treatment combining antiviral and neutralizing antibody-based therapies with monitoring of spike-specific antibody and viral load for immunocompromised patients with persistent COVID-19 infection. Exp Hematol Oncol 2022; 11:53. [PMID: 36085172 PMCID: PMC9462070 DOI: 10.1186/s40164-022-00307-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2022] [Accepted: 09/03/2022] [Indexed: 12/01/2022] Open
Abstract
Because prolonged viral replication of SARS-CoV-2 is increasingly being recognized among immunocompromised patients, subacute or chronic COVID-19 pneumonia can cause persistent lung damage and may lead to viral escape phenomena. Highly efficacious antiviral therapies in immunosuppressed hosts with COVID-19 are urgently needed. From February 2022, we introduced novel treatment combining antiviral therapies and neutralizing antibodies with frequent monitoring of spike-specific antibody and RT-PCR cycle threshold (Ct) values as indicators of viral load for immunocompromised patients with persistent COVID-19 infection. We applied this treatment to 10 immunosuppressed patients with COVID-19, and all completed treatment without relapse of infection. This may be a potentially successful treatment strategy that enables us to sustain viral clearance, determine optimal timing to stop treatment, and prevent virus reactivation in immunocompromised patients with persistent COVID-19.
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11
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Maruyama S, Nakamori Y, Nakano H, Tsuyumu K, Kanayama S, Iwamura H, Wada D, Yoshihara T, Saito F, Yoshiya K, Kuwagata Y. Peak value of serum KL-6 may be useful for predicting poor prognosis of severe COVID-19 patients. Eur J Med Res 2022; 27:69. [PMID: 35590343 PMCID: PMC9118822 DOI: 10.1186/s40001-022-00690-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2021] [Accepted: 04/22/2022] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Serum Krebs von den Lungen 6 (KL-6), which reflects alveolar epithelial injury, was reported to be useful to predict the progression of pneumonitis induced by COVID-19 in the early phase. This study aimed to evaluate the peak value of serum KL-6 during hospitalization for COVID-19 to discover a more useful biomarker for predicting prognosis in COVID-19 patients. METHODS In this retrospective, single-center, observational study, we analyzed the data of 147 hospitalized patients who required supplemental oxygen, high-flow oxygen therapy, or invasive mechanical ventilation for respiratory failure due to COVID-19 from March 2020 to February 2021. We extracted data on patient sex, age, comorbidities, treatment, and biomarkers including the initial and peak values of KL-6. Inclusion criteria were examination of the studied biomarkers at least once within 3 days of admission, then at least once a week, and at a minimum, at least twice during the entire hospitalization. Area under the receiver operating curve (AUC) was analyzed to determine the accuracy of several biomarkers including KL-6 and LDH for predicting poor prognosis defined as survivors requiring invasive mechanical ventilation for over 28 days or non-survivors of COVID-19. Univariable and multivariate logistic regression analyses were performed to investigate the prognostic value of the baseline characteristics and biomarkers. RESULTS Among the 147 patients, 108 (73.5%) had a good prognosis and 39 (26.5%) had a poor prognosis. The AUC analysis indicated that peak KL-6 showed precise accuracy in the discrimination of patients with poor prognosis (AUC 0.89, p < 0.001). The best cut-off value for KL-6 concentration was 966 U/mL (sensitivity 81.6%, specificity84.3%). After adjustment, increasing peak values of KL-6 or LDH were associated with a high risk of poor prognosis, with an adjusted odds ratio of 1.35 for peak value of KL-6, per 100 U/mL increase (95% CI 1.17-1.57, p < 0.001) and 2.16 for peak value of LDH, per 100 U/L increase (95% CI 1.46-3.20, p < 0.001). CONCLUSIONS Peak values of KL-6 and LDH measured during hospitalization might help to identify COVID-19 patients with respiratory failure who are at higher risk for a poor prognosis.
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Affiliation(s)
- Shuhei Maruyama
- Department of Emergency and Critical Care Medicine, Kansai Medical University Medical Center, 10-15 Fumizono-cho, Moriguchi, Osaka 570-8507 Japan
| | - Yasushi Nakamori
- Department of Emergency and Critical Care Medicine, Kansai Medical University Medical Center, 10-15 Fumizono-cho, Moriguchi, Osaka 570-8507 Japan
| | - Hitoshi Nakano
- Department of Emergency and Critical Care Medicine, Kansai Medical University Medical Center, 10-15 Fumizono-cho, Moriguchi, Osaka 570-8507 Japan
| | - Keiko Tsuyumu
- Department of Emergency and Critical Care Medicine, Kansai Medical University Medical Center, 10-15 Fumizono-cho, Moriguchi, Osaka 570-8507 Japan
| | - Shuji Kanayama
- Department of Emergency and Critical Care Medicine, Kansai Medical University Medical Center, 10-15 Fumizono-cho, Moriguchi, Osaka 570-8507 Japan
| | - Hiromu Iwamura
- Department of Emergency and Critical Care Medicine, Kansai Medical University Medical Center, 10-15 Fumizono-cho, Moriguchi, Osaka 570-8507 Japan
| | - Daiki Wada
- Department of Emergency and Critical Care Medicine, Kansai Medical University Medical Center, 10-15 Fumizono-cho, Moriguchi, Osaka 570-8507 Japan
| | - Tomoyuki Yoshihara
- Department of Emergency and Critical Care Medicine, Kansai Medical University Medical Center, 10-15 Fumizono-cho, Moriguchi, Osaka 570-8507 Japan
| | - Fukuki Saito
- Department of Emergency and Critical Care Medicine, Kansai Medical University Medical Center, 10-15 Fumizono-cho, Moriguchi, Osaka 570-8507 Japan
| | - Kazuhisa Yoshiya
- Department of Emergency and Critical Care Medicine, Kansai Medical University Medical Center, 10-15 Fumizono-cho, Moriguchi, Osaka 570-8507 Japan
| | - Yasuyuki Kuwagata
- Department of Emergency and Critical Care Medicine, Kansai Medical University Hospital, 2-3-1 Shinmachi, Hirakata, Osaka 573-1191 Japan
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12
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Takahashi H, Muroya T, Okamoto Y, Tamagaki K, Maeshima K, Onoe A, Nakamura F, Nakajima M, Sakuramoto K, Kajino K, Ikegawa H, Kuwagata Y. Lacosamide poisoning improved by hemodialysis. Acute Med Surg 2022; 9:e775. [PMID: 35924090 PMCID: PMC9340780 DOI: 10.1002/ams2.775] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Accepted: 07/18/2022] [Indexed: 11/12/2022] Open
Affiliation(s)
- Hiroki Takahashi
- Department of Emergency and Critical Care Medicine Kansai Medical University Hirakata Japan
| | - Takashi Muroya
- Department of Emergency and Critical Care Medicine Kansai Medical University Hirakata Japan
| | - Yasutaka Okamoto
- Department of Emergency and Critical Care Medicine Kansai Medical University Hirakata Japan
| | - Keisuke Tamagaki
- Department of Emergency and Critical Care Medicine Kansai Medical University Hirakata Japan
| | - Kenji Maeshima
- Department of Emergency and Critical Care Medicine Kansai Medical University Hirakata Japan
| | - Atsunori Onoe
- Department of Emergency and Critical Care Medicine Kansai Medical University Hirakata Japan
| | - Fumiko Nakamura
- Department of Emergency and Critical Care Medicine Kansai Medical University Hirakata Japan
| | - Mari Nakajima
- Department of Emergency and Critical Care Medicine Kansai Medical University Hirakata Japan
| | - Kazuhito Sakuramoto
- Department of Emergency and Critical Care Medicine Kansai Medical University Hirakata Japan
| | - Kentarou Kajino
- Department of Emergency and Critical Care Medicine Kansai Medical University Hirakata Japan
| | - Hitoshi Ikegawa
- Department of Emergency and Critical Care Medicine Kansai Medical University Hirakata Japan
| | - Yasuyuki Kuwagata
- Department of Emergency and Critical Care Medicine Kansai Medical University Hirakata Japan
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13
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Katayama Y, Kitamura T, Tanaka J, Nakao S, Nitta M, Fujimi S, Kuwagata Y, Shimazu T, Matsuoka T. Factors associated with prolonged hospitalization among patients transported by emergency medical services: A population-based study in Osaka, Japan. Medicine (Baltimore) 2021; 100:e27862. [PMID: 35049188 PMCID: PMC9191281 DOI: 10.1097/md.0000000000027862] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2020] [Accepted: 11/01/2021] [Indexed: 11/25/2022] Open
Abstract
The emergency medical system, one of the essential elements of public health, has been around for more than 50 years. Although many studies have assessed the factors associated with overcrowding and prolonged length of stay in emergency departments, whether the clinical characteristics and background of a patient are associated with prolonged hospitalization among patients transported by ambulance is unknown. The purpose of this study was to reveal factors associated with the continuation of hospitalization at 21 days after hospital admission among patients transported by ambulance using a population-based patient registry in Osaka, Japan.This was a retrospective observational study whose study period was the three years from January 2016 to December 2018. In this study, we included patients who were hospitalized after transportation by ambulance in Osaka, Japan. The main outcome was continuation of hospitalization at 21 days after hospital admission. We calculated the adjusted odds ratios (AOR) and 95% confidence interval (CI) with a multivariable logistic regression model to assess factors associated with the outcome.We included 481,886 patients in this study, of whom 158,551 remained hospitalized at 21 days after hospital admission and 323,335 had been discharged home by 21 days after hospital admission. Factors associated with prolonged hospitalization were elderly (AOR: 1.767 [95% CI: 1.730-1.805]), traffic accident (AOR: 1.231 [95% CI: 1.183-1.282]), no fixed address (AOR: 4.494 [95% CI: 3.632-5.314]), need for nursing care (AOR: 1.420 [95% CI: 1.397-1.443]) and solitary person (AOR: 1.085 [95% CI: 1.050-1.120]).In this study, the elderly, traffic accidents, no fixed address, need for nursing care, and solitary person were associated with prolonged hospitalization of patients transported by ambulance in Japan.
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Affiliation(s)
- Yusuke Katayama
- Department of Traumatology and Acute Critical Medicine, Osaka University Graduate School of Medicine, Suita, Japan
| | - Tetsuhisa Kitamura
- Department of Social and Environmental Medicine, Division of Environmental Medicine, Osaka University Graduate School of Medicine, Suita, Japan
| | - Jun Tanaka
- Osaka Prefectural Government, Osaka, Japan
| | - Shota Nakao
- Rinku General Medical Center, Senshu Trauma and Critical Care Center, Izumisano, Japan
| | - Masahiko Nitta
- Department of Emergency Medicine, Osaka Medical College, Takatsuki, Japan
| | - Satoshi Fujimi
- Division of Trauma and Surgical Critical Care, Osaka General Medical Center, Osaka, Japan
| | - Yasuyuki Kuwagata
- Department of Emergency and Critical Care Medicine, Kansai Medical University, Hirakata, Japan
| | - Takeshi Shimazu
- Department of Traumatology and Acute Critical Medicine, Osaka University Graduate School of Medicine, Suita, Japan
| | - Tetsuya Matsuoka
- Rinku General Medical Center, Senshu Trauma and Critical Care Center, Izumisano, Japan
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14
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Hirose T, Katayama Y, Tanaka K, Kitamura T, Nakao S, Tachino J, Nakao S, Nitta M, Iwami T, Fujimi S, Uejima T, Miyamoto Y, Baba T, Mizobata Y, Kuwagata Y, Shimazu T, Matsuoka T. Reduction of influenza in Osaka, Japan during the COVID-19 outbreak: a population-based ORION registry study. IJID Regions 2021; 1:79-81. [PMID: 35721776 PMCID: PMC8514326 DOI: 10.1016/j.ijregi.2021.10.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/03/2021] [Revised: 10/06/2021] [Accepted: 10/08/2021] [Indexed: 01/22/2023]
Abstract
No reports using a population-based registry to evaluate COVID-19 impact on influenza The Osaka Prefecture government created the ORION registry ORION is the Osaka Emergency Information Research Intelligent Operation Network ORION records emergency patients treated by emergency medical service (EMS) personnel Number of influenza patients transported by EMS decreased during COVID-19 pandemic
Objectives Methods Results Conclusions
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Affiliation(s)
- Tomoya Hirose
- The Working Group to Analyze the Emergency Medical Care System in Osaka Prefecture
- Department of Traumatology and Acute Critical Medicine, Osaka University Graduate School of Medicine, 2-15 Yamadaoka, Suita, Osaka 565-0871, Japan
- Corresponding author. Tomoya Hirose, MD, PhD, Department of Traumatology and Acute Critical Medicine, Osaka University Graduate School of Medicine, 2-15 Yamadaoka, Suita, Osaka 565-0871, Japan. Tel.: +81-6-6879-5707; Fax: +81-6-6879-5720.
| | - Yusuke Katayama
- The Working Group to Analyze the Emergency Medical Care System in Osaka Prefecture
- Department of Traumatology and Acute Critical Medicine, Osaka University Graduate School of Medicine, 2-15 Yamadaoka, Suita, Osaka 565-0871, Japan
| | - Kenta Tanaka
- Division of Environmental Medicine and Population Sciences, Department of Social and Environmental Medicine, Osaka University Graduate School of Medicine, 2-15 Yamadaoka, Suita, Osaka 565-0871, Japan
| | - Tetsuhisa Kitamura
- The Working Group to Analyze the Emergency Medical Care System in Osaka Prefecture
- Division of Environmental Medicine and Population Sciences, Department of Social and Environmental Medicine, Osaka University Graduate School of Medicine, 2-15 Yamadaoka, Suita, Osaka 565-0871, Japan
| | - Shunichiro Nakao
- The Working Group to Analyze the Emergency Medical Care System in Osaka Prefecture
- Department of Traumatology and Acute Critical Medicine, Osaka University Graduate School of Medicine, 2-15 Yamadaoka, Suita, Osaka 565-0871, Japan
| | - Jotaro Tachino
- The Working Group to Analyze the Emergency Medical Care System in Osaka Prefecture
- Department of Traumatology and Acute Critical Medicine, Osaka University Graduate School of Medicine, 2-15 Yamadaoka, Suita, Osaka 565-0871, Japan
| | - Shota Nakao
- The Working Group to Analyze the Emergency Medical Care System in Osaka Prefecture
- Senshu Trauma and Critical Care Center, Rinku General Medical Center, 2-23 Rinku-orai kita, Izumisano, Osaka 598-8577, Japan
| | - Masahiko Nitta
- The Working Group to Analyze the Emergency Medical Care System in Osaka Prefecture
- Department of Emergency Medicine, Osaka Medical and Pharmaceutical University, 2-7 Daigaku-machi, Takatsuki, Osaka 596-8686, Japan
| | - Taku Iwami
- The Working Group to Analyze the Emergency Medical Care System in Osaka Prefecture
- Kyoto University Health Service, Yoshida Honmachi, Sakyo-ku, Kyoto 606-8501, Japan
| | - Satoshi Fujimi
- The Working Group to Analyze the Emergency Medical Care System in Osaka Prefecture
- Department of Emergency Medicine, Osaka General Medical Center, 3-1-56 Bandai-Higashi, Sumiyoshi-ku, Osaka, Osaka 558-8558, Japan
| | - Toshifumi Uejima
- The Working Group to Analyze the Emergency Medical Care System in Osaka Prefecture
- Department of Acute Medicine, Kindai University, 377-2 Ohnohigashi, Osakasayama, Osaka 589-8511, Japan
| | - Yuji Miyamoto
- The Working Group to Analyze the Emergency Medical Care System in Osaka Prefecture
- Otemae Hospital, 1-5-34 Otemae, Chuo-ku, Osaka, Osaka 540-0008, Japan
| | - Takehiko Baba
- The Working Group to Analyze the Emergency Medical Care System in Osaka Prefecture
- Baba Memorial Hospital, 4-244 Hamadera Funaocho-higashi, Nishi-ku, Sakai, Osaka 592-8555, Japan
| | - Yasumitsu Mizobata
- The Working Group to Analyze the Emergency Medical Care System in Osaka Prefecture
- Department of Trauma and Critical Care Medicine, Osaka City University Graduate School of Medicine, 1-4-3 Asahimachi, Abeno-ku, Osaka, Osaka 545-8585, Japan
| | - Yasuyuki Kuwagata
- The Working Group to Analyze the Emergency Medical Care System in Osaka Prefecture
- Department of Emergency and Critical Care Medicine, Kansai Medical University Hospital, 2-3-1 Shinmachi, Hirakata, Osaka 573-1191, Japan
| | - Takeshi Shimazu
- Department of Emergency Medicine, Osaka General Medical Center, 3-1-56 Bandai-Higashi, Sumiyoshi-ku, Osaka, Osaka 558-8558, Japan
| | - Tetsuya Matsuoka
- The Working Group to Analyze the Emergency Medical Care System in Osaka Prefecture
- Senshu Trauma and Critical Care Center, Rinku General Medical Center, 2-23 Rinku-orai kita, Izumisano, Osaka 598-8577, Japan
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15
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Katayama Y, Tanaka K, Kitamura T, Takeuchi T, Nakao S, Nitta M, Iwami T, Fujimi S, Uejima T, Miyamoto Y, Baba T, Mizobata Y, Kuwagata Y, Shimazu T, Matsuoka T. Incidence and Mortality of Emergency Patients Transported by Emergency Medical Service Personnel during the Novel Corona Virus Pandemic in Osaka Prefecture, Japan: A Population-Based Study. J Clin Med 2021; 10:5662. [PMID: 34884363 PMCID: PMC8658143 DOI: 10.3390/jcm10235662] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2021] [Revised: 11/26/2021] [Accepted: 11/27/2021] [Indexed: 12/11/2022] Open
Abstract
Although the COVID-19 pandemic affects the emergency medical service (EMS) system, little is known about the impact of the COVID-19 pandemic on the prognosis of emergency patients. This study aimed to reveal the impact of the COVID-19 pandemic on the EMS system and patient outcomes. We included patients transported by ambulance who were registered in a population-based registry of patients transported by ambulance. The endpoints of this study were the incident number of patients transported by ambulance each month and the number of deaths among these patients admitted to hospital each month. The incidence rate ratio (IRR) and 95% confidence interval (CI) using a Poisson regression model with the year 2019 as the reference were calculated. A total of 500,194 patients were transported in 2019, whereas 443,321 patients were transported in 2020, indicating a significant decrease in the number of emergency patients transported by ambulance (IRR: 0.89, 95% CI: 0.88-0.89). The number of deaths of emergency patients admitted to hospital was 11,931 in 2019 and remained unchanged at 11,963 in 2020 (IRR: 1.00, 95% CI: 0.98-1.03). The incidence of emergency patients transported by ambulance decreased during the COVID-19 pandemic in 2020, but the mortality of emergency patients admitted to hospital did not change in this study.
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Affiliation(s)
- Yusuke Katayama
- Department of Traumatology and Acute Critical Medicine, Osaka University Graduate School of Medicine, Suita 565-0871, Japan;
| | - Kenta Tanaka
- Department of Social and Environmental Medicine, Division of Environmental Medicine and Population Sciences, Osaka University Graduate School of Medicine, Suita 565-0871, Japan; (K.T.); (T.K.); (T.T.)
| | - Tetsuhisa Kitamura
- Department of Social and Environmental Medicine, Division of Environmental Medicine and Population Sciences, Osaka University Graduate School of Medicine, Suita 565-0871, Japan; (K.T.); (T.K.); (T.T.)
| | - Taro Takeuchi
- Department of Social and Environmental Medicine, Division of Environmental Medicine and Population Sciences, Osaka University Graduate School of Medicine, Suita 565-0871, Japan; (K.T.); (T.K.); (T.T.)
| | - Shota Nakao
- Senshu Trauma and Critical Care Center, Rinku General Medical Center, Izumisano 598-8577, Japan; (S.N.); (T.M.)
| | - Masahiko Nitta
- Department of Emergency Medicine, Osaka Medical and Pharmaceutical University, Takatsuki 569-8686, Japan;
| | - Taku Iwami
- Kyoto University Health Service, Kyoto 606-8501, Japan;
| | - Satoshi Fujimi
- Division of Trauma and Surgical Critical Care, Osaka General Medical Center, Osaka 558-8558, Japan;
| | - Toshifumi Uejima
- Emergency Care Center, Kindai University Hospital, Osaka-Sayama 589-8511, Japan;
| | | | | | - Yasumitsu Mizobata
- Department of Traumatology and Critical Care Medicine, Osaka City University Graduate School of Medicine, Osaka 558-8585, Japan;
| | - Yasuyuki Kuwagata
- Department of Emergency and Critical Care Medicine, Kansai Medical University, Hirakata 573-1010, Japan;
| | - Takeshi Shimazu
- Department of Traumatology and Acute Critical Medicine, Osaka University Graduate School of Medicine, Suita 565-0871, Japan;
| | - Tetsuya Matsuoka
- Senshu Trauma and Critical Care Center, Rinku General Medical Center, Izumisano 598-8577, Japan; (S.N.); (T.M.)
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16
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Tanaka K, Morikawa K, Katayama Y, Kitamura T, Sobue T, Nakao S, Nitta M, Iwami T, Fujimi S, Uejima T, Miyamoto Y, Baba T, Mizobata Y, Kuwagata Y, Matsuoka T, Shimazu T. G20 Summit and emergency medical services in Osaka, Japan. Acute Med Surg 2021; 8:e661. [PMID: 34012552 PMCID: PMC8112478 DOI: 10.1002/ams2.661] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Revised: 04/11/2021] [Accepted: 04/15/2021] [Indexed: 11/20/2022] Open
Abstract
Aim To assess the impact of the Summit on Financial Markets and the World Economy held in Osaka City, Japan (G20 Osaka Summit) on the emergency medical services (EMS) system. Methods This study used the ORION database with its population‐based registry of emergency patients comprising both ambulance and in‐hospital records in Osaka Prefecture, Japan. The G20 Osaka Summit was held in Osaka City from 28 to 29 June, 2019. Changes in the EMS system and traffic regulations in Osaka were made during the period from 27 to 30 June, but we focused on the two summit days as the G20 period. The control periods comprised the same calendar days 1 week before and 1 week after the G20 period. We evaluated differences in the number of emergency transports, difficulties in obtaining hospital acceptance of patients, deaths among hospitalized emergency patients, and ambulance transport times between the two periods. Results In total, 2,590 cases in the G20 period and 5,152 cases in the control periods were registered. The relative risk of cases during the G20 versus control periods was 1.01 (0.96–1.05). Significant decreases were observed in the number of traffic accidents as ambulance calls (relative risk = 0.77; 95% confidence interval, 0.64–0.91). There were no significant differences in difficulties in obtaining hospital acceptance or deaths among hospitalized emergency patients between the G20 and control periods. In addition, ambulance transport times during the G20 period were not significantly longer than those in the control periods. Conclusion The G20 Osaka Summit did not adversely impact the provision of emergency medical care in the Osaka area.
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Affiliation(s)
- Kenta Tanaka
- Department of Social and Environmental Medicine Graduate School of Medicine Osaka University Suita Japan
| | - Kosuke Morikawa
- Graduate School of Engineering Science Osaka University Toyonaka Japan
| | - Yusuke Katayama
- Department of Traumatology and Acute Critical Care Osaka University Graduate School of Medicine Suita Japan
| | - Tetsuhisa Kitamura
- Department of Social and Environmental Medicine Graduate School of Medicine Osaka University Suita Japan
| | - Tomotaka Sobue
- Department of Social and Environmental Medicine Graduate School of Medicine Osaka University Suita Japan
| | - Shota Nakao
- Rinku General Medical Center Senshu Trauma and Critical Care Center Izumisano Japan
| | - Masahiko Nitta
- Department of Emergency Medicine Osaka Medical and Pharmaceutical University Takatsuki Japan
| | - Taku Iwami
- Kyoto University Health Service Kyoto Japan
| | - Satoshi Fujimi
- Division of Trauma and Surgical Critical Care Osaka General Medical Center Osaka Japan
| | - Toshifumi Uejima
- Emergency Care Center Kindai University Hospital Osaka-Sayama Japan
| | | | | | - Yasumitsu Mizobata
- Department of Traumatology and Critical Care Medicine Osaka City University Graduate School of Medicine Osaka Japan
| | - Yasuyuki Kuwagata
- Department of Emergency and Critical Care Medicine Kansai Medical University Hirakata Japan
| | - Tetsuya Matsuoka
- Rinku General Medical Center Senshu Trauma and Critical Care Center Izumisano Japan
| | - Takeshi Shimazu
- Department of Traumatology and Acute Critical Care Osaka University Graduate School of Medicine Suita Japan
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Wada D, Hayakawa K, Saito F, Yoshiya K, Nakamori Y, Kuwagata Y. Combined brain and thoracic trauma surgery in a hybrid emergency room system: a case report. BMC Surg 2021; 21:219. [PMID: 33906660 PMCID: PMC8076875 DOI: 10.1186/s12893-021-01218-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2020] [Accepted: 04/20/2021] [Indexed: 11/17/2022] Open
Abstract
Background A novel trauma workflow system called the hybrid emergency room (Hybrid ER), which combines a sliding CT scanner system with interventional radiology features (IVR-CT), was initially instituted in our emergency department in 2011. Use of the Hybrid ER enables CT diagnosis and emergency therapeutic interventions without transferring the patient to another room. We describe an illustrative case of severe multiple blunt trauma that included injuries to the brain and torso to highlight the ability to perform multiple procedures in the Hybrid ER. Case presentation A 46-year-old man sustained multiple injuries after falling from height. An early CT scan performed in the Hybrid ER revealed grade IIIa thoracic aortic injury, left lung contusion, and right subdural haematoma and subarachnoid haemorrhage. Without relocating the patient, all definitive procedures, including trepanation, total pneumonectomy, and thoracic endovascular aneurysm repair were performed in the Hybrid ER. At 5.72 h after definitive surgery was begun, the patient was transferred to the intensive care unit. Conclusions The Hybrid ER has the potential to facilitate the performance of multiple definitive procedures in combination to treat severe multiple blunt trauma including injuries to the brain and torso. Emergency departments with more than one resuscitation room would benefit from a Hybrid ER to treat complex emergency cases.
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Affiliation(s)
- Daiki Wada
- Department of Emergency and Critical Care Medicine, Kansai Medical University General Medical Center, 10-15 Fumizono-cho, Moriguchi, Osaka, 570-8507, Japan.
| | - Koichi Hayakawa
- Coordination Office for Emergency Medicine and International Response, Nagasaki University, 1-7-1 Sakamoto, Nagasaki, Nagasaki, 852-8501, Japan
| | - Fukuki Saito
- Department of Emergency and Critical Care Medicine, Kansai Medical University General Medical Center, 10-15 Fumizono-cho, Moriguchi, Osaka, 570-8507, Japan
| | - Kazuhisa Yoshiya
- Department of Emergency and Critical Care Medicine, Kansai Medical University General Medical Center, 10-15 Fumizono-cho, Moriguchi, Osaka, 570-8507, Japan
| | - Yasushi Nakamori
- Department of Emergency and Critical Care Medicine, Kansai Medical University General Medical Center, 10-15 Fumizono-cho, Moriguchi, Osaka, 570-8507, Japan
| | - Yasuyuki Kuwagata
- Department of Emergency and Critical Care Medicine, Kansai Medical University Hospital, 2-3-1 Shinmachi, Hirakata, Osaka, 573-1191, Japan
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18
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Onoe A, Kajino K, Daya MR, Ong MEH, Nakamura F, Nakajima M, Takahashi H, Kishimoto M, Sakuramoto K, Muroya T, Ikegawa H, Kuwagata Y. Outcomes of patients with OHCA of presumed cardiac etiology that did not achieve prehospital restoration of spontaneous circulation: The All-Japan Utstein Registry experience. Resuscitation 2021; 162:245-250. [PMID: 33766662 DOI: 10.1016/j.resuscitation.2021.03.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Revised: 12/18/2020] [Accepted: 03/08/2021] [Indexed: 11/16/2022]
Abstract
BACKGROUND Correct identification of futile prehospital resuscitation for out-of-hospital cardiac arrest (OHCA) may reduce unnecessary transports. Prehospital return of spontaneous circulation (ROSC) is considered by many to be an important predictor of outcome. The purpose of this study was to evaluate OHCA victims without prehospital ROSC characteristics and their outcomes in relation to the universal Termination of Resuscitation (TOR) rule. METHODS A retrospective, population-based review of OHCA victims without prehospital ROSC from January 1, 2010 to December 31, 2017 in the All-Japan Utstein Registry. We compared those that met the universal TOR rule and those that did not for the primary outcome: one-month survival with neurologically favorable Cerebral Performance Category (CPC) 1 or 2. RESULTS 989,929 OHCA cases, 18 years of age or older, were registered in the All-Japan Utstein Registry and 525,801 cases were of presumed cardiac origin and had no prehospital ROSC. Of these, the one-month CPC was 1 or 2 for 3957 cases (0.8%). In the 'no ROSC' group who also met the TOR rule, the number of cases was 433,571 with a one-month survival of 0.9% (3799 cases), and the proportion with a CPC 1or 2 was 0.2% (699 cases). CONCLUSIONS Continued resuscitation and transport of cases with no field ROSC who fulfill the TOR rule is futile and could be considered for adoption in Japan.
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Affiliation(s)
- Atsunori Onoe
- Department of Emergency and Critical Care Medicine, Kansai Medical University, Hirakata, Osaka, Japan.
| | - Kentaro Kajino
- Department of Emergency and Critical Care Medicine, Kansai Medical University, Hirakata, Osaka, Japan
| | - Mohamud R Daya
- Department of Emergency Medicine, Oregon Health & Science University, Portland, OR, USA
| | - Marcus Eng Hock Ong
- Department of Emergency Medicine, Singapore General Hospital, Singapore; Health Services and Systems Research, Duke-NUS Medical School, Singapore
| | - Fumiko Nakamura
- Department of Emergency and Critical Care Medicine, Kansai Medical University, Hirakata, Osaka, Japan
| | - Mari Nakajima
- Department of Emergency and Critical Care Medicine, Kansai Medical University, Hirakata, Osaka, Japan
| | - Hiroki Takahashi
- Department of Emergency and Critical Care Medicine, Kansai Medical University, Hirakata, Osaka, Japan
| | - Masanobu Kishimoto
- Department of Emergency and Critical Care Medicine, Kansai Medical University, Hirakata, Osaka, Japan
| | - Kazuhito Sakuramoto
- Department of Emergency and Critical Care Medicine, Kansai Medical University, Hirakata, Osaka, Japan
| | - Takashi Muroya
- Department of Emergency and Critical Care Medicine, Kansai Medical University, Hirakata, Osaka, Japan
| | - Hitoshi Ikegawa
- Department of Emergency and Critical Care Medicine, Kansai Medical University, Hirakata, Osaka, Japan
| | - Yasuyuki Kuwagata
- Department of Emergency and Critical Care Medicine, Kansai Medical University, Hirakata, Osaka, Japan
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19
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Nakahori Y, Shimizu K, Ogura H, Asahara T, Osuka A, Yamano S, Tasaki O, Kuwagata Y, Shimazu T. Impact of fecal short-chain fatty acids on prognosis in critically ill patients. Acute Med Surg 2020; 7:e558. [PMID: 32864147 PMCID: PMC7447560 DOI: 10.1002/ams2.558] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Revised: 07/24/2020] [Accepted: 07/27/2020] [Indexed: 11/24/2022] Open
Abstract
Aim This study aimed to evaluate the relationship between fecal organic acids and mortality in critically ill patients. Methods This retrospective study included 128 patients who fulfilled the criteria of systemic inflammatory response syndrome and had a serum C‐reactive protein level of greater than 10 mg/dL. Patients were treated in the intensive care unit for more than 2 days. Patients were divided into two groups: survivors and non‐survivors. We measured and compared eight kinds of fecal organic acids between the two groups. We focused on the minimum and maximum value of each fecal organic acid and evaluated prognostic factors by using classification and regression tree (CART) and multivariate logistic regression analyses. Results We included 90 patients as survivors and 38 as non‐survivors. The CART analysis revealed that the dominant factors for mortality were the minimum values of propionate and acetate and the maximum values of lactate and formic acid. In the evaluation of the minimum values of fecal organic acids, propionate was significantly associated with increased mortality (odds ratio, 0.11 [95% confidence interval, 0.024–0.51]; P = 0.005), acetate (0.047 [0.005–0.49]; P = 0.01), and age (1.048 [1.015–1.083]; P = 0.004). In the evaluation of the maximum values, lactate was significantly associated with increased mortality (5.21 [2.024–13.42], P = 0.001) and age (1.050 [1.017–1.084]; P = 0.003). Conclusion An altered balance of fecal organic acids was significantly associated with mortality in critically ill patients.
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Affiliation(s)
- Yasutaka Nakahori
- Division of Trauma and Surgical Critical Care Osaka General Medical Center Osaka Japan.,Department of Traumatology and Acute Critical Medicine Osaka University Graduate School of Medicine Osaka Japan
| | - Kentaro Shimizu
- Department of Traumatology and Acute Critical Medicine Osaka University Graduate School of Medicine Osaka Japan
| | - Hiroshi Ogura
- Department of Traumatology and Acute Critical Medicine Osaka University Graduate School of Medicine Osaka Japan
| | | | - Akinori Osuka
- Department of Trauma Critical Care Medicine and Burn Center Chukyo Hospital Aichi Japan
| | - Shuhei Yamano
- Acute and Critical Care Center Nagasaki University Hospital Nagasaki Japan
| | - Osamu Tasaki
- Acute and Critical Care Center Nagasaki University Hospital Nagasaki Japan
| | - Yasuyuki Kuwagata
- Department of Emergency and Critical Care Medicine Kansai Medical University Osaka Japan
| | - Takeshi Shimazu
- Department of Traumatology and Acute Critical Medicine Osaka University Graduate School of Medicine Osaka Japan
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20
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Terashima S, Muroya T, Ikegawa H, Kajino K, Sakuramoto K, Yui R, Kishimoto M, Takahashi H, Nakajima M, Nakamura F, Nakamori Y, Kuwagata Y. Propofol suppresses ventricular arrhythmias: a case report of acute caffeine intoxication. Acute Med Surg 2020; 7:e514. [PMID: 32537172 PMCID: PMC7283990 DOI: 10.1002/ams2.514] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2019] [Revised: 04/06/2020] [Accepted: 04/16/2020] [Indexed: 11/18/2022] Open
Abstract
Background Caffeine is widely used as a stimulant drug throughout the world, and fatal arrhythmia is a known side‐effect. We experienced a patient with caffeine intoxication causing fatal arrhythmias who was successfully treated with the infusion of propofol. Case Presentation A 27‐year‐old woman was transferred to our hospital with nausea and poor general condition after intentional ingestion of 23.2 g of caffeine tablets. She was in cardiac arrest due to ventricular fibrillation just before hospital arrival. Advanced life support including defibrillation was started immediately, and we succeeded in resuscitating her 23 min later. Although she suffered from polymorphic ventricular premature beats and frequent transition to ventricular fibrillation, propofol administration converted her from a ventricular arrhythmia to sinus rhythm. Conclusion We report this case focusing on the cardiovascular effects of propofol and the lipid sink phenomenon. As a result, propofol could have the potential to suppress ventricular arrhythmias.
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Affiliation(s)
- Shinya Terashima
- Department of Emergency and Critical Care Medicine Kansai Medical University Medical Center Moriguchi Japan
| | - Takashi Muroya
- Department of Emergency and Critical Care Medicine Kansai Medical University Hospital Hirakata Japan
| | - Hitoshi Ikegawa
- Department of Emergency and Critical Care Medicine Kansai Medical University Hospital Hirakata Japan
| | - Kentaro Kajino
- Department of Emergency and Critical Care Medicine Kansai Medical University Hospital Hirakata Japan
| | - Kazuhito Sakuramoto
- Department of Emergency and Critical Care Medicine Kansai Medical University Hospital Hirakata Japan
| | - Rintaro Yui
- Department of Emergency and Critical Care Medicine Kansai Medical University Hospital Hirakata Japan
| | - Masanobu Kishimoto
- Department of Emergency and Critical Care Medicine Kansai Medical University Hospital Hirakata Japan
| | - Hiroki Takahashi
- Department of Emergency and Critical Care Medicine Kansai Medical University Hospital Hirakata Japan
| | - Mari Nakajima
- Department of Emergency and Critical Care Medicine Kansai Medical University Hospital Hirakata Japan
| | - Fumiko Nakamura
- Department of Emergency and Critical Care Medicine Kansai Medical University Hospital Hirakata Japan
| | - Yasushi Nakamori
- Department of Emergency and Critical Care Medicine Kansai Medical University Medical Center Moriguchi Japan
| | - Yasuyuki Kuwagata
- Department of Emergency and Critical Care Medicine Kansai Medical University Hospital Hirakata Japan
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21
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Terashima S, Hayakawa K, Saito F, Wada D, Iwamura H, Kuro A, Ozaki Y, Nakamori Y, Ishii K, Kuwagata Y. Hemophagocytic syndrome with severe sepsis caused by Capnocytophaga canimorsus. Am J Emerg Med 2020; 38:1540.e5-1540.e8. [PMID: 32197716 DOI: 10.1016/j.ajem.2020.03.017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2019] [Revised: 03/02/2020] [Accepted: 03/09/2020] [Indexed: 12/16/2022] Open
Abstract
Capnocytophaga canimorsus, commonly transmitted by dog bites, can cause severe sepsis, and the mortality rate is very high. We experienced a case of hemophagocytic lymphohistiocytosis (HLH) complicated by severe sepsis caused by C. canimorsus. A 58-year-old man with no remarkable medical history was admitted to another hospital with fever and mild consciousness disorder developed 3 days after being bitten by his dog. The next day, the patient developed disseminated intravascular coagulation and shock and was transferred to our emergency medical center. Blood tests showed hyperferritinemia and cytopenia, and bone marrow aspiration was performed. As a result, we diagnosed severe sepsis and HLH. Once antibiotic and steroid therapy was started, the patient's infection and cytopenia improved. Unfortunately, the patient's fingers and toes required amputation, but his life was saved, and he was discharged from hospital. Because HLH may be hidden in such cases, it may be necessary to measure serum ferritin and perform bone marrow aspiration if hyperferritinemia is suspected.
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Affiliation(s)
- Shinya Terashima
- Department of Emergency and Critical Care Medicine, Kansai Medical University Medical Center, 10-15 Fumizono-cho, Moriguchi, Osaka 570-8507, Japan.
| | - Koichi Hayakawa
- Department of Emergency and Critical Care Medicine, Kansai Medical University Medical Center, 10-15 Fumizono-cho, Moriguchi, Osaka 570-8507, Japan.
| | - Fukuki Saito
- Department of Emergency and Critical Care Medicine, Kansai Medical University Medical Center, 10-15 Fumizono-cho, Moriguchi, Osaka 570-8507, Japan.
| | - Daiki Wada
- Department of Emergency and Critical Care Medicine, Kansai Medical University Medical Center, 10-15 Fumizono-cho, Moriguchi, Osaka 570-8507, Japan.
| | - Hiromu Iwamura
- Department of Emergency and Critical Care Medicine, Kansai Medical University Medical Center, 10-15 Fumizono-cho, Moriguchi, Osaka 570-8507, Japan.
| | - Atsuyuki Kuro
- Department of Plastic and Reconstructive Surgery, Kansai Medical University Medical Center, 10-15 Fumizono-cho, Moriguchi, Osaka 570-8507, Japan.
| | - Yujiro Ozaki
- Department of Plastic and Reconstructive Surgery, Kansai Medical University Medical Center, 10-15 Fumizono-cho, Moriguchi, Osaka 570-8507, Japan.
| | - Yasushi Nakamori
- Department of Emergency and Critical Care Medicine, Kansai Medical University Medical Center, 10-15 Fumizono-cho, Moriguchi, Osaka 570-8507, Japan.
| | - Kazuyoshi Ishii
- Department of Hematology, Kansai Medical University Medical Center, 10-15 Fumizono-cho, Moriguchi, Osaka 570-8507, Japan.
| | - Yasuyuki Kuwagata
- Department of Emergency and Critical Care Medicine, Kansai Medical University Hospital, 2-3-1 Shinmachi, Hirakata, Osaka 573-1191, Japan.
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22
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Nakamura F, Kajino K, Kitamura T, Daya MR, Ong ME, Matsuyama T, Yamada T, Hayakawa K, Irisawa T, Yoshiya K, Noguchi K, Nishimura T, Uejima T, Yagi Y, Kiguchi T, Kishimoto M, Matsuura M, Hayashi Y, Sogabe T, Morooka T, Iwami T, Shimazu T, Kuwagata Y. Impact of age on survival of patients with out-of-hospital cardiac arrest transported to tertiary emergency medical institutions in Osaka, Japan. Geriatr Gerontol Int 2019; 19:1088-1095. [PMID: 31622019 DOI: 10.1111/ggi.13779] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Revised: 07/27/2019] [Accepted: 08/17/2019] [Indexed: 11/30/2022]
Abstract
AIM The purpose of this study was to evaluate the out-of-hospital cardiac arrest (OHCA) characteristics of patients stratified by age who had resuscitation attempted and were transported to tertiary emergency medical institutions in Osaka Prefecture, Japan; especially those of advanced age. METHODS A prospective, population-based, observational review was carried out of consecutive OHCA patients with emergency responder resuscitation attempts from July 2012 to December 2016 in Osaka, Japan. Patients were classified into four groups: (i) 18-64 years; (ii) 65-74 years; (iii) 75-84 years; and (iv) ≥85 years. Patient, event and treatment characteristics were examined for patients with presumed cardiac etiology of OHCA. The primary outcome was the 1-month survival with a neurologically favorable outcome. RESULTS A total of 4636 patients with OHCA of presumed cardiac origin were transported to tertiary emergency medical institutions. The number of patients in the four groups was as follows: (i) 1290 (27.8%); (ii) 1102 (23.8%); (iii) 1420 (30.6%); and (iv) 824 (17.8%). The 1-month survival with a neurologically favorable outcome was: (i) 207 (16.0%); (ii) 96 (8.7%); (iii) 60 (4.2%); and (iv) seven (0.85%). In a multivariate analysis for 1-month survival with a neurologically favorable outcome, increased age was a significant prognostic factor (≥85 years; adjusted odds ratio 0.08, 95% confidence interval 0.03-0.23) for poor outcomes. CONCLUSIONS In this population, advanced age (≥85 years) was strongly associated with poor outcomes. Further discussion of policies directed at resuscitation of very elderly OHCA patients is required, considering limited medical resources and the rapidly aging population in Japan. Geriatr Gerontol Int 2019; 19: 1088-1095.
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Affiliation(s)
- Fumiko Nakamura
- Department of Emergency and Critical Care Medicine, Kansai Medical University, Osaka, Japan
| | - Kentaro Kajino
- Department of Emergency and Critical Care Medicine, Kansai Medical University, Osaka, Japan
| | - Tetsuhisa Kitamura
- Division of Environmental Medicine and Population Sciences, Department of Social and Environmental Medicine, Graduate School of Medicine, Osaka University, Osaka, Japan
| | - Mohamud R Daya
- Department of Emergency Medicine, Oregon Health & Science University, Portland, Oregon, USA
| | - Marcus Eh Ong
- Department of Emergency Medicine, Singapore General Hospital, Singapore
| | - Tasuku Matsuyama
- Department of Emergency Medicine, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Tomoki Yamada
- Emergency and Critical Care Medical Center, Osaka Police Hospital, Osaka, Japan
| | - Koichi Hayakawa
- Department of Emergency and Critical Care Medicine, Kansai Medical University Medical Center, Osaka, Japan
| | - Taro Irisawa
- Department of Traumatology and Acute Critical Medicine, Osaka University Graduate School of Medicine, Suita, Japan
| | - Kazuhisa Yoshiya
- Department of Traumatology and Acute Critical Medicine, Osaka University Graduate School of Medicine, Suita, Japan
| | - Kazuo Noguchi
- Department of Emergency Medicine, Tane General Hospital, Osaka, Japan
| | - Tetsuro Nishimura
- Department of Critical Care Medicine, Osaka City University, Osaka, Japan
| | - Toshifumi Uejima
- Department of Emergency and Critical Care Medicine, Kinki University School of Medicine, Osaka-Sayama, Japan
| | - Yoshiki Yagi
- Osaka Mishima Emergency Critical Care Center, Takatsuki, Japan
| | | | - Masafumi Kishimoto
- Osaka Prefectural Nakakawachi Medical Center of Acute Medicine, Higashi-Osaka, Japan
| | | | - Yasuyuki Hayashi
- Senri Critical Care Medical Center, Saiseikai Senri Hospital, Suita, Japan
| | - Taku Sogabe
- Traumatology and Critical Care Medical Center, National Hospital Organization Osaka National Hospital, Osaka, Japan
| | - Takaya Morooka
- Emergency and Critical Care Medical Center, Osaka City General Hospital, Osaka, Japan
| | - Taku Iwami
- Kyoto University Health Services, Kyoto, Japan
| | - Takeshi Shimazu
- Department of Traumatology and Acute Critical Medicine, Osaka University Graduate School of Medicine, Suita, Japan
| | - Yasuyuki Kuwagata
- Department of Emergency and Critical Care Medicine, Kansai Medical University, Osaka, Japan
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23
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Muratsu A, Muroya T, Kishimoto M, Kuwagata Y. Gastric emphysema with portal emphysema due to superior mesenteric artery syndrome developing septic shock: a case report. Acute Med Surg 2019; 6:404-407. [PMID: 31592323 PMCID: PMC6773641 DOI: 10.1002/ams2.440] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2019] [Accepted: 06/08/2019] [Indexed: 11/26/2022] Open
Abstract
Background Superior mesenteric artery syndrome (SMAS) is often associated with gastric dilatation but, very rarely, it can be associated with gastric emphysema. In addition, there are few reported cases accompanied by septic shock. Case Presentation A 64‐year‐old man was transferred to our hospital with vomiting and abdominal distention. He went into shock and showed impaired consciousness. Blood biochemistry tests showed elevated levels of C‐reactive protein. An abdominal computed tomography scan revealed a dilated stomach and proximal duodenum, and constriction of the third portion of the duodenum with gastric and portal emphysema. We thus diagnosed him with gastric and portal emphysema associated with SMAS that progressed to septic shock. We treated him conservatively by giving antibiotics and undertaking gastric drainage and feeding by way of the jejunum through a double elementary diet tube. Conclusion This is the first report to describe a case of SMAS with gastric and portal emphysema that progressed to septic shock.
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Affiliation(s)
- Arisa Muratsu
- Department of Emergency and Critical Care Medicine Kansai Medical University Hirakata Japan
| | - Takashi Muroya
- Department of Emergency and Critical Care Medicine Kansai Medical University Hirakata Japan
| | - Masanobu Kishimoto
- Department of Emergency and Critical Care Medicine Kansai Medical University Hirakata Japan
| | - Yasuyuki Kuwagata
- Department of Emergency and Critical Care Medicine Kansai Medical University Hirakata Japan
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24
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Nakamura F, Yui R, Muratsu A, Sakuramoto K, Muroya T, Ikegawa H, Kuwagata Y. Study of the prognostic factor of the colon perforation case with the pan-peritonitis that needed emergency surgery: a single-center observational study. Acute Med Surg 2019; 6:379-384. [PMID: 31592322 PMCID: PMC6773627 DOI: 10.1002/ams2.429] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2018] [Accepted: 04/07/2019] [Indexed: 12/02/2022] Open
Abstract
Aim We divided patients treated with emergency surgery for pan‐peritonitis caused by colon perforation into the survival group and the death group based on outcome at postoperative day 30 and examined the prognostic factors for colon perforation. Methods The prognostic factors for colon perforation in 76 consecutive patients who underwent emergency surgery at Kansai Medical University Hospital (Hirakata, Japan) from April 2011 to March 2017 were investigated based on outcome at postoperative day 30. Results The average age of the 76 patients (41 men/35 women) was 73 years, and the causative disease of colon perforation was malignant/benign in 18/58 cases, with ileocecal perforation site in 8 cases, ascending colon in 6, transverse colon in 2, descending colon in 4, sigmoid colon in 49, and rectum in 7. All patients received laparotomy with irrigation drainage, and 9 patients (11.8%) were dead at 30 days. Upon comparing the 67 survivors with the 9 dead patients, we recognized a significant difference on preoperative spread of ascites on computed tomography (CT) (P = 0.002) in univariate analysis and on acute disseminated intravascular coagulation (DIC) score (odds ratio 2.289; 95% confidence interval, 1.188–4.410; P = 0.013) in multivariate analysis. Conclusion In our hospital, the preoperative acute DIC score was found to be a prognostic factor for colon perforation accompanied by pan‐peritonitis. Appropriate evaluation of the spread of ascites on the preoperative CT might also help predict patient prognosis.
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Affiliation(s)
- Fumiko Nakamura
- Department of Emergency and Critical Care Medicine Kansai Medical University Hirakata Osaka Japan
| | - Rintaro Yui
- Department of Emergency and Critical Care Medicine Kansai Medical University Hirakata Osaka Japan
| | - Arisa Muratsu
- Department of Emergency and Critical Care Medicine Kansai Medical University Hirakata Osaka Japan
| | - Kazuhito Sakuramoto
- Department of Emergency and Critical Care Medicine Kansai Medical University Hirakata Osaka Japan
| | - Takashi Muroya
- Department of Emergency and Critical Care Medicine Kansai Medical University Hirakata Osaka Japan
| | - Hitoshi Ikegawa
- Department of Emergency and Critical Care Medicine Kansai Medical University Hirakata Osaka Japan
| | - Yasuyuki Kuwagata
- Department of Emergency and Critical Care Medicine Kansai Medical University Hirakata Osaka Japan
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Muratsu A, Muroya T, Yui R, Nakamura F, Kishimoto M, Sakuramoto K, Kuwagata Y. Factors associated with bowel necrosis in patients with hepatic portal venous gas and pneumatosis intestinalis. Acute Med Surg 2019; 7:e432. [PMID: 31988756 PMCID: PMC6971442 DOI: 10.1002/ams2.432] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2018] [Accepted: 04/26/2019] [Indexed: 11/26/2022] Open
Abstract
Aim Historically, the presence of hepatic portal venous gas (HPVG) and pneumatosis intestinalis (PI) have been reported to be associated with bowel necrosis and fatal outcome. However, there are no criteria to judge whether bowel necrosis has occurred. We aimed to examine the factors associated with bowel necrosis in patients with HPVG and PI. Methods The study comprised 25 patients who were diagnosed as having HPVG and/or PI based on computed tomography (CT) findings in the Department of Emergency and Critical Care Medicine, Kansai Medical University Hospital (Osaka, Japan) between April 2013 and August 2017. We compared various factors, including clinical history, severity of present illness, laboratory data, and CT findings, and examined whether they were related to bowel necrosis. Results Both Sequential Organ Failure Assessment scores and total bilirubin levels were significantly higher in the necrosis group than those in the non‐necrosis group (P = 0.03 and P = 0.02, respectively). The quantity of portal venous gas observed on computed tomography was associated with bowel necrosis in patients with HPVG. In contrast, the presence of air‐type PI, defined as PI with emphysema covering the total circumference of the intestine in the absence of wall edema, and the presence of free air were significantly higher in the non‐necrosis group (both P < 0.01). Conclusions This study showed that the quantity of HPVG was associated with bowel necrosis, whereas the presence of free air or air‐type PI was associated with non‐necrosis of the bowel.
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Affiliation(s)
- Arisa Muratsu
- Department of Emergency and Critical Care Medicine Kansai Medical University Osaka Japan
| | - Takashi Muroya
- Department of Emergency and Critical Care Medicine Kansai Medical University Osaka Japan
| | - Rintaro Yui
- Department of Emergency and Critical Care Medicine Kansai Medical University Osaka Japan
| | - Fumiko Nakamura
- Department of Emergency and Critical Care Medicine Kansai Medical University Osaka Japan
| | - Masanobu Kishimoto
- Department of Emergency and Critical Care Medicine Kansai Medical University Osaka Japan
| | - Kazuhito Sakuramoto
- Department of Emergency and Critical Care Medicine Kansai Medical University Osaka Japan
| | - Yasuyuki Kuwagata
- Department of Emergency and Critical Care Medicine Kansai Medical University Osaka Japan
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Nakamura F, Yui R, Muratsu A, Onoe A, Nakajima M, Takahashi H, Kishimoto M, Sakuramoto K, Muroya T, Kajino K, Ikegawa H, Kuwagata Y. A strategy for improving the prognosis of non-occlusive mesenteric ischemia (NOMI): a single-center observational study. Acute Med Surg 2019; 6:365-370. [PMID: 31592320 PMCID: PMC6773662 DOI: 10.1002/ams2.422] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2018] [Accepted: 03/28/2019] [Indexed: 01/13/2023] Open
Abstract
Aim The purpose of this study was to determine the prognostic factors of non‐occlusive mesenteric ischemia (NOMI) and to examine treatment strategies that could improve its prognosis. Methods We retrospectively identified 30 patients who underwent emergency laparotomy for NOMI in Kansai Medical University Hospital (Hirakata, Japan) from April 2013 to December 2017. We examined prognostic factors related to discharge outcome and also examined the prognostic impact of open abdominal management and second look operation strategy (OSS) by dividing the patients into the non‐OSS group and the OSS group. Results The primary end‐point was a prognostic factor for outcome at discharge of the 30 patients. The outcome at discharge was compared between the survival group and the death group. Multivariate analysis was undertaken on two items from the univariate analysis that showed a significant difference (computed tomography findings of intestinal pneumatosis and acute disseminated intravascular coagulation [DIC] score). As a result, there was a significant difference in the factors of intestinal pneumatosis (odds ratio = 0.054; 95% confidence interval, 0.005–0.607; P = 0.018) and DIC score (odds ratio = 1.892; 95% confidence interval, 1.077–3.323; P = 0.027). The secondary end‐point was the treatment outcome before and after the application of OSS. Operation time was significantly shorter and the amount of bleeding was also significantly less in the OSS group. Conclusion Computed tomography findings of intestinal pneumatosis and the acute disseminated intravascular coagulation score were found to be prognostic factors for survival in patients with NOMI. Aggressive laparotomy to determine the definitive diagnosis is needed and OSS could be useful to improve patient prognosis for survival from NOMI.
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Affiliation(s)
- Fumiko Nakamura
- Department of Emergency and Critical Care Medicine Kansai Medical University Hirakata Osaka Japan
| | - Rintaro Yui
- Department of Emergency and Critical Care Medicine Kansai Medical University Hirakata Osaka Japan
| | - Arisa Muratsu
- Department of Emergency and Critical Care Medicine Kansai Medical University Hirakata Osaka Japan
| | - Atsunori Onoe
- Department of Emergency and Critical Care Medicine Kansai Medical University Hirakata Osaka Japan
| | - Mari Nakajima
- Department of Emergency and Critical Care Medicine Kansai Medical University Hirakata Osaka Japan
| | - Hiroki Takahashi
- Department of Emergency and Critical Care Medicine Kansai Medical University Hirakata Osaka Japan
| | - Masanobu Kishimoto
- Department of Emergency and Critical Care Medicine Kansai Medical University Hirakata Osaka Japan
| | - Kazuhito Sakuramoto
- Department of Emergency and Critical Care Medicine Kansai Medical University Hirakata Osaka Japan
| | - Takashi Muroya
- Department of Emergency and Critical Care Medicine Kansai Medical University Hirakata Osaka Japan
| | - Kentaro Kajino
- Department of Emergency and Critical Care Medicine Kansai Medical University Hirakata Osaka Japan
| | - Hitoshi Ikegawa
- Department of Emergency and Critical Care Medicine Kansai Medical University Hirakata Osaka Japan
| | - Yasuyuki Kuwagata
- Department of Emergency and Critical Care Medicine Kansai Medical University Hirakata Osaka Japan
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Wada D, Hayakawa K, Maruyama S, Saito F, Kaneda H, Nakamori Y, Kuwagata Y. A paediatric case of severe tracheobronchial injury successfully treated surgically after early CT diagnosis and ECMO safely performed in the hybrid emergency room. Scand J Trauma Resusc Emerg Med 2019; 27:49. [PMID: 31014372 PMCID: PMC6480442 DOI: 10.1186/s13049-019-0628-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2019] [Accepted: 04/10/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND In paediatric trauma patients, tracheobronchial injury can be a rare, life-threatening trauma. In 2011, we instituted a new trauma workflow concept called the hybrid emergency room (Hybrid ER) that combines a sliding CT scanning system with interventional radiology features to permit CT examination and emergency therapeutic intervention without moving the patient. Extracorporeal membrane oxygenation (ECMO) can lead to cannula-related complications. However, procedures supported by moveable C-arm fluoroscopy and ultrasonography equipment can be performed soon after early CT examination. We report a paediatric patient with tracheobronchial injury diagnosed by CT examination who underwent rapid resuscitation and safe installation of veno-venous (VV) ECMO in our Hybrid ER and was successfully treated by surgery. CASE PRESENTATION A 11-year-old boy was admitted to our Hybrid ER suffering blunt chest trauma. His vital signs were unstable with low oxygen saturation. Early CT examination was performed without relocation. CT revealed bilateral hemopneumothorax, bilateral lung contusion, left multiple rib fractures, and right bronchus intermedius injury. Because his oxygenation was severely low with a PaO2/FiO2 ratio (P/F) of 109, he was at very high risk during transport to the operating room and changing to one-lung ventilation. Thus, we established VV ECMO in the Hybrid ER before we performed thoracotomy under left lung ventilation in the operating room. After the P/F ratio improved, he was transferred to the operating room under VV ECMO. We performed middle- and lower-lobe resection and sutured the stump of the right bronchus intermedius to treat the complete tear of this branch. After his respiratory function recovered, VV ECMO was removed on postoperative day 5. After in-patient rehabilitation, he was discharged home on postoperative day 68 without sequelae. CONCLUSIONS It is feasible to perform VV ECMO in the Hybrid ER, but one case does not conclude it is safe. In this case, the blood oxygenation improved, but there are no evidence to support the safety of the procedure or the advantage of ECMO initiation in the Hybrid ER rather than in the operating room.
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Affiliation(s)
- Daiki Wada
- Department of Emergency and Critical Care Medicine, Kansai Medical University Medical Center, 10-15 Fumizono-cho, Moriguchi, Osaka, 570-8507 Japan
| | - Koichi Hayakawa
- Department of Emergency and Critical Care Medicine, Kansai Medical University Medical Center, 10-15 Fumizono-cho, Moriguchi, Osaka, 570-8507 Japan
| | - Shuhei Maruyama
- Department of Emergency and Critical Care Medicine, Kansai Medical University Medical Center, 10-15 Fumizono-cho, Moriguchi, Osaka, 570-8507 Japan
| | - Fukuki Saito
- Department of Emergency and Critical Care Medicine, Kansai Medical University Medical Center, 10-15 Fumizono-cho, Moriguchi, Osaka, 570-8507 Japan
| | - Hiroyuki Kaneda
- Department of Thoracic Surgery, Kansai Medical University Medical Center, 10-15 Fumizono-cho, Moriguchi, Osaka, 570-8507 Japan
| | - Yasushi Nakamori
- Department of Emergency and Critical Care Medicine, Kansai Medical University Medical Center, 10-15 Fumizono-cho, Moriguchi, Osaka, 570-8507 Japan
| | - Yasuyuki Kuwagata
- Department of Emergency and Critical Care Medicine, Kansai Medical University Hospital, 2-3-1 Shinmachi, Hirakata, Osaka, 573-1191 Japan
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Abstract
Aims An angiographic examination is necessary for the diagnosis of takotsubo cardiomyopathy (TTC). However, in the intensive care unit (ICU), intensivists often see patients in whom TTC cannot be diagnosed because they cannot undertake angiography due to the patient's poor general condition. We defined such cases as clinical TTC (cTTC) and investigated the incidence and background of cTTC in the ICU at Kansai Medical University Hospital (Osaka, Japan). Methods The study involved 5,084 patients who were admitted to the ICU of Kansai Medical University Hospital between January 2013 and December 2017. We retrospectively investigated the frequency and background of TTC and cTTC. Results Of the 5,084 patients, 5 (0.09%) patients admitted to the ICU were diagnosed as having TTC and 19 patients (0.37%) were diagnosed as having cTTC. The most common primary disease among the evaluated patients was sepsis (n = 10) followed by subarachnoid hemorrhage (SAH) (n = 5). Ten of the 335 patients with sepsis (3.0%) were admitted to the ICU with complications due to cTTC. Their blood pressure and heart rate on admission tended to be high, and their Sequential Organ Failure Assessment scores tended to be low. Five of the 172 patients with SAH (2.9%) were admitted to the ICU with complications due to cTTC. These patients were often classified as grade 5 on the Hunt and Hess scale. Conclusion Our study suggests that patients with sepsis or SAH are complicated with cTTC in the ICU. In addition, there might be no correlation between the severity of sepsis and the development of TTC.
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Affiliation(s)
- Arisa Muratsu
- Department of Emergency and Critical Care Medicine Kansai Medical University Osaka Japan
| | - Takashi Muroya
- Department of Emergency and Critical Care Medicine Kansai Medical University Osaka Japan
| | - Yasuyuki Kuwagata
- Department of Emergency and Critical Care Medicine Kansai Medical University Osaka Japan
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Okamoto J, Katayama Y, Kitamura T, Sado J, Nakamura R, Kimura N, Misaki H, Yamao S, Nakao S, Nitta M, Iwami T, Fujimi S, Kuwagata Y, Shimazu T, Matsuoka T. Profile of the ORION (Osaka emergency information Research Intelligent Operation Network system) between 2015 and 2016 in Osaka, Japan: a population-based registry of emergency patients with both ambulance and in-hospital records. Acute Med Surg 2018; 6:12-24. [PMID: 30651993 PMCID: PMC6328924 DOI: 10.1002/ams2.371] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2018] [Accepted: 08/07/2018] [Indexed: 11/16/2022] Open
Abstract
Aim To describe the registry design of the Osaka Emergency Information Research Intelligent Operation Network system (ORION) and its profile of hospital information, patient and emergency medical service characteristics, and in‐hospital outcomes among all patients transported to critical care centers and emergency hospitals in Osaka Prefecture, Japan. Methods The Osaka Prefecture Government has developed and introduced an information system for emergency patients (the ORION system) that uses a smartphone application (app) for hospital selection by on‐scene emergency medical service personnel and has been accumulating all ambulance records. Since January 2015, medical institutions have obtained information on the diagnosis and outcome of patients transported to medical institutions, and the ORION system merged these data with ambulance records including smartphone app data. Results From January 2015 to December 2016, 753,301 eligible patients were registered. The mean age was 58.7 years, and 51.5% of patients were male. After hospital arrival, 39.7% were hospitalized, 58.2% were discharged from hospital, 1.1% changed hospital, and 1.0% died. The most common diagnoses were injury, poisoning, and certain other consequences of external causes. Among the hospitalized patients, 29.2% were continuously hospitalized, 59.0% discharged, 5.2% changed hospital, and 5.8% were dead at 21 days after hospitalization. The most common confirmed diagnosis was diseases of the circulatory system. Conclusion Using the ORION system developed and operated by Osaka Prefecture since January 2015, we described the epidemiological data of all emergency patients transported to emergency hospitals. Analysis using the ORION database in the future could lead to improvements in the emergency transport system and patient outcomes.
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Affiliation(s)
| | - Yusuke Katayama
- Department of Traumatology and Acute Critical Medicine Osaka University Graduate School of Medicine Suita Japan
| | - Tetsuhisa Kitamura
- Department of Social and Environmental Medicine Division of Environmental Medicine and Population Sciences Osaka University Graduate School of Medicine Suita Japan
| | - Junya Sado
- Department of Health and Sports Sciences Medicine for Sports and Performing Arts Osaka University Graduate School of Medicine Suita Japan
| | | | | | | | | | - Shota Nakao
- Rinku General Medical Center Senshu Trauma and Critical Care Center Izumisano Japan
| | - Masahiko Nitta
- Department of Emergency Medicine Osaka Medical College Takatsuki Japan
| | - Taku Iwami
- Kyoto University Health Service Kyoto Japan
| | - Satoshi Fujimi
- Division of Trauma and Surgical Critical Care Osaka General Medical Center Osaka Japan
| | - Yasuyuki Kuwagata
- Department of Emergency and Critical Care Medicine Kansai Medical University Osaka Japan
| | - Takeshi Shimazu
- Department of Traumatology and Acute Critical Medicine Osaka University Graduate School of Medicine Suita Japan
| | - Tetsuya Matsuoka
- Rinku General Medical Center Senshu Trauma and Critical Care Center Izumisano Japan
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Wada D, Nakamori Y, Kanayama S, Maruyama S, Kawada M, Iwamura H, Hayakawa K, Saito F, Kuwagata Y. First installation of a dual-room IVR-CT system in the emergency room. Scand J Trauma Resusc Emerg Med 2018; 26:17. [PMID: 29506552 PMCID: PMC5836362 DOI: 10.1186/s13049-018-0484-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2017] [Accepted: 02/27/2018] [Indexed: 11/26/2022] Open
Abstract
Computed tomography (CT) embedded in the emergency room has gained importance in the early diagnostic phase of trauma care. In 2011, we implemented a new trauma workflow concept with a sliding CT scanner system with interventional radiology features (IVR-CT) that allows CT examination and emergency therapeutic intervention without relocating the patient, which we call the Hybrid emergency room (Hybrid ER). In the Hybrid ER, all life-saving procedures, CT examination, damage control surgery, and transcatheter arterial embolisation can be performed on the same table. Although the trauma workflow realized in the Hybrid ER may improve mortality in severe trauma, the Hybrid ER can potentially affect the efficacy of other in/outpatient diagnostic workflow because one room is occupied by one severely injured patient undergoing both emergency trauma care and CT scanning for long periods. In July 2017, we implemented a new trauma workflow concept with a dual-room sliding CT scanner system with interventional radiology features (dual-room IVR-CT) to increase patient throughput. When we perform emergency surgery or interventional radiology for a severely injured or ill patient in the Hybrid ER, the sliding CT scanner moves to the adjacent CT suite, and we can perform CT scanning of another in/outpatient. We believe that dual-room IVR-CT can contribute to the improvement of both the survival of severely injured or ill patients and patient throughput.
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Affiliation(s)
- Daiki Wada
- Department of Emergency and Critical Care Medicine, Kansai Medical University Medical Center, 10-15 Fumizono-cho, Moriguchi, Osaka, 570-8507, Japan.
| | - Yasushi Nakamori
- Department of Emergency and Critical Care Medicine, Kansai Medical University Medical Center, 10-15 Fumizono-cho, Moriguchi, Osaka, 570-8507, Japan
| | - Shuji Kanayama
- Department of Emergency and Critical Care Medicine, Kansai Medical University Medical Center, 10-15 Fumizono-cho, Moriguchi, Osaka, 570-8507, Japan
| | - Shuhei Maruyama
- Department of Emergency and Critical Care Medicine, Kansai Medical University Medical Center, 10-15 Fumizono-cho, Moriguchi, Osaka, 570-8507, Japan
| | - Masahiro Kawada
- Department of Emergency and Critical Care Medicine, Kansai Medical University Medical Center, 10-15 Fumizono-cho, Moriguchi, Osaka, 570-8507, Japan
| | - Hiromu Iwamura
- Department of Emergency and Critical Care Medicine, Kansai Medical University Medical Center, 10-15 Fumizono-cho, Moriguchi, Osaka, 570-8507, Japan
| | - Koichi Hayakawa
- Department of Emergency and Critical Care Medicine, Kansai Medical University Medical Center, 10-15 Fumizono-cho, Moriguchi, Osaka, 570-8507, Japan
| | - Fukuki Saito
- Department of Emergency and Critical Care Medicine, Kansai Medical University Medical Center, 10-15 Fumizono-cho, Moriguchi, Osaka, 570-8507, Japan
| | - Yasuyuki Kuwagata
- Department of Emergency and Critical Care Medicine, Kansai Medical University Hospital, 2-3-1 Shinmachi, Hirakata, Osaka, 573-1191, Japan
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Wada D, Hayakawa K, Kanayama S, Maruyama S, Iwamura H, Miyama N, Saito F, Nakamori Y, Kuwagata Y. A case of blunt thoracic aortic injury requiring ECMO for acute malperfusion before TEVAR. Scand J Trauma Resusc Emerg Med 2017; 25:110. [PMID: 29166938 PMCID: PMC5700754 DOI: 10.1186/s13049-017-0456-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2017] [Accepted: 11/16/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Blunt thoracic aortic injury (BTAI) is associated with a high mortality rate and the paradigm of treating patients with BTAI currently favours thoracic endovascular aneurysm repair (TEVAR) if possible. In BTAI, lethal malperfusion caused by a pseudoaneurysm has rarely been reported. We present the first report of a successful case in which a pseudoaneurysm causing the infrequent occurrence of lethal malperfusion and subsequent acute severe ischaemia in the distal portion of the thoracic descending aorta was overcome by veno-arterial extracorporeal membrane oxygenation (VA ECMO) as a bridging therapy until the initiation of TEVAR. CASE PRESENTATION An adult woman was transferred to our emergency room after injuries sustained by falling from height. Her vital signs were unstable on admission. CT examination revealed the multiple injuries: traumatic subarachnoid haemorrhage, severe unstable pelvic fracture, and a grade III injury of the thoracic aorta. We made the decision to perform TEVAR after external fixation and transcatheter arterial embolization (TAE) for the pelvic injury. During preparations for TEVAR, her lower limbs rapidly felt cold, and her blood lactate level and serum potassium rapidly increased. By the clinical data and ultrasonography and lower extremity Doppler, we diagnosed severe ischaemia in distal portion of the descending aorta caused by a pseudoaneurysm proximal to the descending thoracic aorta. Because we still had not prepared for TEVAR, we immediately started VA ECMO until TEVAR could begin. After the initiation of VA ECMO, her lactate and potassium levels could be controlled. Under VA ECMO support, she underwent TEVAR. After inpatient rehabilitation, she was discharged home without neurologic sequelae. CONCLUSIONS VA ECMO could be an important, less-invasive treatment as a bridging therapy for acute severe malperfusion syndrome until TEVAR is initiated for BTAI.
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Affiliation(s)
- Daiki Wada
- Department of Emergency and Critical Care Medicine, Kansai Medical University Medical Center, 10-15 Fumizono-cho, Moriguchi, Osaka, 570-8507, Japan.
| | - Koichi Hayakawa
- Department of Emergency and Critical Care Medicine, Kansai Medical University Medical Center, 10-15 Fumizono-cho, Moriguchi, Osaka, 570-8507, Japan
| | - Shuji Kanayama
- Department of Emergency and Critical Care Medicine, Kansai Medical University Medical Center, 10-15 Fumizono-cho, Moriguchi, Osaka, 570-8507, Japan
| | - Shuhei Maruyama
- Department of Emergency and Critical Care Medicine, Kansai Medical University Medical Center, 10-15 Fumizono-cho, Moriguchi, Osaka, 570-8507, Japan
| | - Hiromu Iwamura
- Department of Emergency and Critical Care Medicine, Kansai Medical University Medical Center, 10-15 Fumizono-cho, Moriguchi, Osaka, 570-8507, Japan
| | - Noriyuki Miyama
- Department of Vascular Surgery, Kansai Medical University Medical Center, 10-15 Fumizono-cho, Moriguchi, Osaka, 570-8507, Japan
| | - Fukuki Saito
- Department of Emergency and Critical Care Medicine, Kansai Medical University Medical Center, 10-15 Fumizono-cho, Moriguchi, Osaka, 570-8507, Japan
| | - Yasushi Nakamori
- Department of Emergency and Critical Care Medicine, Kansai Medical University Medical Center, 10-15 Fumizono-cho, Moriguchi, Osaka, 570-8507, Japan
| | - Yasuyuki Kuwagata
- Department of Emergency and Critical Care Medicine, Kansai Medical University Hospital, 2-3-1 Shinmachi, Hirakata, Osaka, 573-1191, Japan
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Ikeura T, Horibe M, Sanui M, Sasaki M, Kuwagata Y, Nishi K, Kariya S, Sawano H, Goto T, Hamada T, Oda T, Yasuda H, Ogura Y, Miyazaki D, Hirose K, Kitamura K, Chiba N, Ozaki T, Yamashita T, Koinuma T, Oshima T, Yamamoto T, Hirota M, Yamamoto S, Oe K, Ito T, Iwasaki E, Kanai T, Okazaki K, Mayumi T. Validation of the efficacy of the prognostic factor score in the Japanese severity criteria for severe acute pancreatitis: A large multicenter study. United European Gastroenterol J 2017; 5:389-397. [PMID: 28507751 PMCID: PMC5415216 DOI: 10.1177/2050640616670566] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2016] [Accepted: 08/29/2016] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND The Japanese severity criteria for acute pancreatitis (AP), which consist of a prognostic factor score and contrast-enhanced computed tomography grade, have been widely used in Japan. OBJECTIVE This large multicenter retrospective study was conducted to validate the predictive value of the prognostic factor score for mortality and complications in severe AP patients in comparison to the Acute Physiology and Chronic Health Evaluation II (APACHE II) score. METHODS Data of 1159 patients diagnosed with severe AP according to the Japanese severity criteria for AP were retrospectively collected in 44 institutions. RESULTS The area under the curve (AUC) for the receiver-operating characteristic curve of the prognostic factor score for predicting mortality was 0.78 (95% confidence interval (CI), 0.74-0.82), whereas the AUC for the APACHE II score was 0.80 (95% CI, 0.76-0.83), respectively. There were no significant differences in the AUC for predicting mortality between two scoring systems. The AUCs of the prognostic factor scores for predicting the need for mechanical ventilation, the development of pancreatic infection, and severe AP according to the revised Atlanta classification were 0.84 (95% CI, 0.81-0.86), 0.73 (95% CI, 0.69-0.77), and 0.83 (95% CI, 0.81-0.86), respectively, which were significantly greater than the AUCs for the APACHE II score; 0.81 (95% CI, 0.78-0.83) for the need for mechanical ventilation (p = 0.03), 0.68 (95% CI, 0.63-0.72) for the development of pancreatic infection (p = 0.02), and 0.80 (95% CI, 0.77-0.82) for severe AP according to the revised Atlanta classification (p = 0.01). CONCLUSION The prognostic factor score has an equivalent ability for predicting mortality compared with the APACHE II score. Regarding the ability for predicting the development of severe complications during the clinical course of AP, the prognostic factor score may be superior to the APACHE II score.
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Affiliation(s)
- Tsukasa Ikeura
- Department of Gastroenterology and Hepatology, Kansai Medical University, Osaka, Japan
| | - Masayasu Horibe
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Keio University School of Medicine, Tokyo, Japan
- Department of Gastroenterology and Hepatology, Tokyo Metropolitan Tama Medical Center, Tokyo, Japan
| | - Masamitsu Sanui
- Department of Anesthesiology and Critical Care Medicine, Jichi Medical University, Saitama, Japan
- Masamitsu Sanui, Department of Anesthesiology and Critical Care Medicine, Jichi Medical University Saitama Medical Center, 1-847 Amanumachou, Omiya-ku, Saitama, 330-8503, Japan.
| | - Mitsuhito Sasaki
- Department of Hepatobiliary and Pancreatic Oncology, National Cancer Center Hospital, Tokyo, Japan
| | - Yasuyuki Kuwagata
- Department of Emergency and Critical Care Medicine, Kansai Medical University, Osaka, Japan
| | - Kenichiro Nishi
- Department of Anesthesiology, Kansai Medical University, Osaka, Japan
| | - Shuji Kariya
- Department of Radiology, Kansai Medical University, Osaka, Japan
| | - Hirotaka Sawano
- Senri Critical Care Medical Center, Osaka Saiseikai Senri Hospital, Osaka, Japan
| | - Takashi Goto
- Department of Anesthesiology and Intensive Care, Hiroshima City Hiroshima Citizens Hospital, Hiroshima, Japan
| | - Tsuyoshi Hamada
- Department of Gastroenterology, The University of Tokyo, Tokyo, Japan
| | - Takuya Oda
- Department of General Internal Medicine, Iizuka Hospital, Fukuoka, Japan
| | - Hideto Yasuda
- Department of Emergency and Critical Care Medicine, Japanese Red Cross Musashino Hospital, Tokyo, Japan
| | - Yuki Ogura
- Department of Gastroenterology and Hepatology, Tokyo Metropolitan Tama Medical Center, Tokyo, Japan
| | - Dai Miyazaki
- Advanced Emergency Medical and Critical Care Center, Japanese Redcross Maebashi Hospital, Gunma, Japan
| | - Kaoru Hirose
- Department of Emergency Medicine, Shonan Kamakura General Hospital, Kanagawa, Japan
| | - Katsuya Kitamura
- Division of Gastroenterology, Showa University School of Medicine, Tokyo, Japan
| | - Nobutaka Chiba
- Department of Emergency and Critical Care Medicine, Nihon University Hospital, Tokyo, Japan
| | - Tetsu Ozaki
- Department of Acute Care and General Medicine, Saiseikai Kumamoto Hospital, Kumamoto, Japan
| | | | - Toshitaka Koinuma
- Division of Intensive Care, Jichi Medical University School of Medicine, Tochigi, Japan
| | - Taku Oshima
- Department of Emergency and Critical Care Medicine, Chiba University Graduate School of Medicine, Chiba, Japan
| | - Tomonori Yamamoto
- Department of Emergency and Critical Care Medicine, Osaka City University, Osaka, Japan
| | - Morihisa Hirota
- Division of Gastroenterology, Tohoku University Hospital, Miyagi, Japan
| | - Satoshi Yamamoto
- Department of Gastroenterology, Fujita Health University, Nagoya, Japan
| | - Kyoji Oe
- Department of Intensive Care Medicine, Asahi General Hospital, Chiba, Japan
| | - Tetsuya Ito
- Department of Medicine, Shinshu University School of Medicine, Nagano, Japan
| | - Eisuke Iwasaki
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Keio University School of Medicine, Tokyo, Japan
| | - Takanori Kanai
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Keio University School of Medicine, Tokyo, Japan
| | - Kazuichi Okazaki
- Department of Gastroenterology and Hepatology, Kansai Medical University, Osaka, Japan
| | - Toshihiko Mayumi
- Department of Emergency Medicine, School of Medicine, University of Occupational and Environmental Health, Fukuoka, Japan
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Yoshioka T, Sugimoto T, Kinoshita N, Shimazu T, Hiraide A, Kuwagata Y. Effects of Concentration Reduction and Partial Replacement of Paraquat by Diquat on Human Toxicity: A Clinical Survey. Hum Exp Toxicol 2016; 11:241-5. [PMID: 1354970 DOI: 10.1177/096032719201100401] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Paraquat poisoning was studied in 174 patients over a 12-month period when a new, low concentration paraquat product (4.5% w/v paraquat ion mixed with 4.5% w/v diquat ion; 6 3 cases) replaced the original high concentration paraquat product (20% w/v paraquat ion only; 111 cases). In both groups approximately 60% of the patients died from circulatory failure accompanied by multiple organ failure within a week of ingesting the products. However, a remarkable reduction in late deaths from respiratory failure was noted in the new product group (17.1% vs 6.3%). This was reflected in this group's improved survival (23.4% vs 34.9%). The improvement in survival seems to be attributable to the dilution of paraquat with diquat which seems to have a different toxicological profile to paraquat.
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Affiliation(s)
- T Yoshioka
- Department of Traumatology, Osaka University School of Medicine, Japan
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Muratsu A, Muroya T, Onoe A, Nakamura F, Wada D, Nakajima M, Iwamura H, Kishimoto M, Yui R, Sakuramoto K, Hayakawa K, Saito F, Nakamori Y, Kuwagata Y. Ventricular septal perforation after blunt chest trauma due to blows from a fist. Acute Med Surg 2016; 3:372-375. [PMID: 29123815 DOI: 10.1002/ams2.176] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2015] [Accepted: 10/06/2015] [Indexed: 10/22/2022] Open
Abstract
Case A 40-year-old man received fist blows to his chest and abdomen. He presented with external jugular vein distention and facial congestion. Chest X-ray showed bilateral pulmonary congestion. A Levine V/VI holosystolic murmur was audible. Echocardiography showed left-to-right shunt flow across the perimembranous region of the ventricular septum. The diameter of the hole was approximately 13 mm. We diagnosed ventricular septal perforation, started an infusion, and administered vasopressors. However, circulatory dynamics could not be maintained. The ventricular septal perforation was repaired directly with mattress sutures through the right ventricle. A small residual ventricular septal perforation was detected, which was repaired with a patch sutured through the left ventricle. Outcome The patient was discharged without cardiovascular complications 43 days after admission. Conclusion Ventricular septal perforation following blunt chest trauma is a rare form of cardiac trauma. It is important to consider the timing of the operation and the best method to ensure cardiac repair.
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Affiliation(s)
- Arisa Muratsu
- Department of Emergency and Critical Care Medicine Kansai Medical University Osaka Japan
| | - Takashi Muroya
- Department of Emergency and Critical Care Medicine Kansai Medical University Osaka Japan
| | - Atsunori Onoe
- Department of Emergency and Critical Care Medicine Kansai Medical University Osaka Japan
| | - Fumiko Nakamura
- Department of Emergency and Critical Care Medicine Kansai Medical University Osaka Japan
| | - Daiki Wada
- Department of Emergency and Critical Care Medicine Kansai Medical University Osaka Japan
| | - Mari Nakajima
- Department of Emergency and Critical Care Medicine Kansai Medical University Osaka Japan
| | - Hiromu Iwamura
- Department of Emergency and Critical Care Medicine Kansai Medical University Osaka Japan
| | - Masanobu Kishimoto
- Department of Emergency and Critical Care Medicine Kansai Medical University Osaka Japan
| | - Rintaro Yui
- Department of Emergency and Critical Care Medicine Kansai Medical University Osaka Japan
| | - Kazuhito Sakuramoto
- Department of Emergency and Critical Care Medicine Kansai Medical University Osaka Japan
| | - Koichi Hayakawa
- Department of Emergency and Critical Care Medicine Kansai Medical University Osaka Japan
| | - Fukuki Saito
- Department of Emergency and Critical Care Medicine Kansai Medical University Osaka Japan
| | - Yasushi Nakamori
- Department of Emergency and Critical Care Medicine Kansai Medical University Osaka Japan
| | - Yasuyuki Kuwagata
- Department of Emergency and Critical Care Medicine Kansai Medical University Osaka Japan
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Sakai T, Kitamura T, Nishiyama C, Murakami Y, Ando M, Kawamura T, Tasaki O, Kuwagata Y, Shimazu T, Iwami T. Cardiopulmonary resuscitation support application on a smartphone - randomized controlled trial. Circ J 2015; 79:1052-7. [PMID: 25740350 DOI: 10.1253/circj.cj-14-1258] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND This simulation trial aimed to compare the quality of cardiopulmonary resuscitation (CPR) with and without the newly-developed CPR support application on smartphones. METHODS AND RESULTS In this trial, participants were randomly assigned to either the CPR support application group or the control group, stratified by sex and previous CPR training. Participants' CPR skills were evaluated by a 2-min case-based scenario test using the Leardal Resusci Anne PC Skill reporting Manikin System(®). The outcome measures were the proportion of chest compressions performed in each group and the number of total chest compressions and appropriate chest compressions performed during the 2-min test period. A total of 84 participants were enrolled and completed the protocol. All participants in the CPR support application group performed chest compressions, compared with only 31 (75.6%) in the control group (P<0.001). Among participants who performed chest compressions during the 2-min test period, the number of total chest compressions was significantly higher in the CPR support application group than in the control group (211.6±29.5 vs. 77.0±43.3, P<0.001). The number of appropriate chest compressions tended to be greater in the CPR support application group than in the control group, although it was statistically insignificant (30.3±57.3 vs. 17.2±28.7, P=0.246). CONCLUSIONS In this cohort of laypersons, the newly-developed CPR support application for smartphones contributed to increasing the implementation rate and the number of total chest compressions performed and may assist in improving the survival rate for out-of-hospital cardiac arrests (UMIN000004740).
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Affiliation(s)
- Tomohiko Sakai
- Department of Traumatology and Acute Critical Medicine, Osaka University Graduate School of Medicine
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Shimizu K, Ogura H, Asahara T, Nomoto K, Matsushima A, Hayakawa K, Ikegawa H, Tasaki O, Kuwagata Y, Shimazu T. Gut microbiota and environment in patients with major burns – a preliminary report. Burns 2014; 41:e28-33. [PMID: 25465986 DOI: 10.1016/j.burns.2014.10.019] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2014] [Revised: 10/07/2014] [Accepted: 10/14/2014] [Indexed: 12/12/2022]
Abstract
INTRODUCTION The gut is an important target organ after severe insult. Gut microbiota have an important role in immune response. However, the gut microbiota and environment have not been clarified in patients with burns. Therefore, we serially evaluated the gut microbiota and environment in patients with major burns. METHODS Fecal samples from five patients with major burns were measured for quantitative evaluation of the gut microbiota. RESULTS In the four survivors of major burns, the numbers of beneficial bacteria, especially those of total obligate anaerobes and Bifidobacterium, initially decreased, but then increased as the condition of the survivors improved. By contrast, the numbers severely decreased in the non-survivor as gut failure and sepsis progressed. The number of pathogenic bacteria such as Pseudomonas and Candida did not continue to increase in the survivors, whereas in the non-survivor the number increased and continued to higher counts. Short-chain fatty acids such as propionic and butyric acids decreased to lower-than-normal levels but tended to increase after recovery in the survivors. The levels remained below normal in the non-survivor. CONCLUSIONS The gut microbiota and environment are severely altered in patients with major burns. Consequently, abnormal gut conditions may have an influence on the systemic inflammatory response and multiple organ dysfunction syndrome. A novel treatment to maintain the gut microbiota and environment is expected in the future.
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Affiliation(s)
- Kentaro Shimizu
- Department of Traumatology and Acute Critical Medicine, Osaka University Graduate School of Medicine, Osaka, Japan.
| | - Hiroshi Ogura
- Department of Traumatology and Acute Critical Medicine, Osaka University Graduate School of Medicine, Osaka, Japan
| | | | | | - Asako Matsushima
- Critical Care & Trauma Center, Osaka General Medical Center, Osaka, Japan
| | - Koichi Hayakawa
- Department of Emergency and Critical Care Medicine, Kansai Medical University, Hirakata-City, Osaka, Japan
| | - Hitoshi Ikegawa
- Department of Traumatology and Acute Critical Medicine, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Osamu Tasaki
- Nagasaki University Hospital Emergency Medical Center, Nagasaki, Japan
| | - Yasuyuki Kuwagata
- Department of Emergency and Critical Care Medicine, Kansai Medical University, Hirakata-City, Osaka, Japan
| | - Takeshi Shimazu
- Department of Traumatology and Acute Critical Medicine, Osaka University Graduate School of Medicine, Osaka, Japan
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Matsuyama S, Hayakawa K, Sakuramoto K, Muroya T, Nakamori Y, Ikegawa H, Shimazu T, Kuwagata Y. Vasodilating prostaglandin E 1 does not reproduce interleukin-1β-induced oxygen metabolism abnormalities in rabbits. Acute Med Surg 2014; 2:40-47. [PMID: 29123689 DOI: 10.1002/ams2.84] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2014] [Accepted: 08/01/2014] [Indexed: 11/10/2022] Open
Abstract
Background We have reported that administration of recombinant human interleukin (IL)-1β induced circulatory shock in rabbits by causing overproduction of vasodilating prostaglandin(s) and simultaneously impaired oxygen metabolism by causing an abnormal dependence of oxygen consumption (VO2) on oxygen delivery (DO2). The present study was carried out to compare the effect of administration of exogenous PGE1 with that of IL-1β on oxygen metabolism. Methods Sixteen rabbits were assigned to one of three groups and given a single injection of 10 μg/kg IL-1β (IL-1β group, n = 5), continuous infusion of 1 μg/kg/min PGE1 (PGE1 group, n = 6), or saline (control group, n = 5). All rabbits were subjected to stepwise cardiac tamponade to decrease DO2 by inflating a balloon placed into the pericardial sac. The VO2/DO2 relation was analyzed by the dual-line method. Results Both IL-1β and PGE1 decreased the baseline value of mean arterial pressure by approximately 25% without inducing significant alteration of the cardiac index. With respect to the VO2/DO2 relation, the slope of the supply-independent line was significantly increased in the IL-1β group (y = 0.13x + 6.4), but not in the PGE1 group (y = 0.01x + 10.0) compared to that in the control group (y = 0.05x + 8.7). Conclusion These results indicate that simple vasodilation and hypotension induced by administration of PGE1 are insufficient to account for the abnormal oxygen metabolism induced by IL-1β.
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Affiliation(s)
| | - Koichi Hayakawa
- Department of Emergency and Critical Care Medicine Kansai Medical University Hirakata-city Japan
| | - Kazuhito Sakuramoto
- Department of Emergency and Critical Care Medicine Kansai Medical University Hirakata-city Japan
| | - Takashi Muroya
- Department of Emergency and Critical Care Medicine Kansai Medical University Hirakata-city Japan
| | - Yasushi Nakamori
- Department of Emergency and Critical Care Medicine Kansai Medical University Hirakata-city Japan
| | - Hitoshi Ikegawa
- Department of Traumatology and Acute Critical Medicine (D-8) Osaka University Medical School Suita-city Osaka Japan
| | - Takeshi Shimazu
- Department of Traumatology and Acute Critical Medicine (D-8) Osaka University Medical School Suita-city Osaka Japan
| | - Yasuyuki Kuwagata
- Department of Emergency and Critical Care Medicine Kansai Medical University Hirakata-city Japan
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Sakai T, Kitamura T, Iwami T, Nishiyama C, Tanigawa-Sugihara K, Hayashida S, Nishiuchi T, Kajino K, Irisawa T, Shiozaki T, Ogura H, Tasaki O, Kuwagata Y, Hiraide A, Shimazu T. Effectiveness of prehospital Magill forceps use for out-of-hospital cardiac arrest due to foreign body airway obstruction in Osaka City. Scand J Trauma Resusc Emerg Med 2014; 22:53. [PMID: 25182381 PMCID: PMC4156961 DOI: 10.1186/s13049-014-0053-3] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2014] [Accepted: 08/21/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Although foreign body airway obstruction (FBAO) accounts for many preventable unintentional accidents, little is known about the epidemiology of FBAO patients and the effect of forceps use on those patients. This study aimed to assess characteristics of FBAO patients transported to hospitals by emergency medical service (EMS) personnel, and to verify the relationship between prehospital Magill forceps use and outcomes among out-of-hospital cardiac arrests (OHCA) patients with FBAO. METHODS We retrospectively reviewed ambulance records of all patients who suffered FBAO, and were treated by EMS in Osaka City from 2000 through 2007, and assessed the characteristics of those patients. We also performed a multivariate logistic-regression analysis to assess factors associated with neurologically favorable survival among bystander-witnessed OHCA patients with FBAO in larynx or pharynx. RESULTS A total of 2,354 patients suffered from FBAO during the study period. There was a bimodal distribution by age among infants and old adults. Among them, 466 (19.8%) had an OHCA when EMS arrived at the scene, and 344 were witnessed by bystanders. In the multivariate analysis, Magill forceps use for OHCA with FBAO in larynx or pharynx was an independent predictor of neurologically favorable survival (16.4% [24/146] in the Magill forceps use group versus 4.3% [4/94] in the non-use group; adjusted odds ratio, 3.96 [95% confidence interval, 1.21-13.00], p = 0.023). CONCLUSIONS From this large registry in Osaka, we revealed that prehospital Magill forceps use was associated with the improved outcome of bystander-witnessed OHCA patients with FBAO.
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Affiliation(s)
- Tomohiko Sakai
- Department of Traumatology and Acute Critical Medicine, Osaka University Graduate School of Medicine, 2-15 Yamadaoka Suita, Osaka 565-0871, Japan.
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Sakai T, Kitamura T, Iwami T, Hayashi Y, Rinka H, Ohishi Y, Mohri T, Kishimoto M, Kawaguchi R, Kajino K, Yumoto T, Uejima T, Nitta M, Nishiuchi T, Shiokawa C, Irisawa T, Tasaki O, Ogura H, Kuwagata Y, Shimazu T. Actual treatments for out-of-hospital ventricular fibrillation at critical care medical centers in Osaka: a pilot descriptive study. Acute Med Surg 2014; 1:150-158. [PMID: 29930839 PMCID: PMC5997189 DOI: 10.1002/ams2.27] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2013] [Accepted: 01/19/2014] [Indexed: 01/23/2023] Open
Abstract
AIM Although advanced treatments are provided to improve outcomes after out-of-hospital ventricular fibrillation, including shock-resistant ventricular fibrillation, the actual treatments in clinical settings have been insufficiently investigated. The aim of the current study is to describe the actual treatments carried out for out-of-hospital ventricular fibrillation patients, including shock-resistant ventricular fibrillation patients, at critical care medical centers. METHODS We registered consecutive adult patients suffering bystander-witnessed out-of-hospital cardiac arrest of cardiac origin, for whom resuscitation was attempted by emergency medical service personnel, who had ventricular fibrillation as an initial rhythm, and who were transported to critical care medical centers in Osaka from March 2008 to December 2008. This study merged data on treatments after transportation, collected from 11 critical care medical centers in Osaka with the prehospital Utstein-style database. RESULTS During the study period, there were 260 bystander-witnessed ventricular fibrillation arrests of cardiac origin. Of them, 252 received defibrillations before hospital arrival, 112 (44.4%) were transported to critical care medical centers, and 35 had shock-resistant ventricular fibrillation. At the critical care medical centers, 54% (19/35), 40% (14/35), and 46% (16/35) of shock-resistant ventricular fibrillation patients were treated with extracorporeal life support, percutaneous coronary interventions, and therapeutic hypothermia, respectively, but their treatments differed among institutions. Some patients with prolonged arrest without prehospital return of spontaneous circulation who received advanced treatments had neurologically favorable survival, whereas approximately two-thirds of shock-resistant ventricular fibrillation patients with advanced treatments did not. CONCLUSION This pilot descriptive study suggested that actual treatments for prehospital ventricular fibrillation patients differed between critical care medical centers. Further studies are warranted to evaluate the effectiveness of in-hospital advanced treatments for ventricular fibrillation including shock-resistant ventricular fibrillation.
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Affiliation(s)
- Tomohiko Sakai
- Department of Traumatology and Acute Critical MedicineOsaka University Graduate School of MedicineOsakaJapan
| | | | - Taku Iwami
- Kyoto University Health ServiceKyotoJapan
| | - Yasuyuki Hayashi
- Senri Critical Care Medical CenterSaiseikai Senri HospitalSuitaJapan
| | - Hiroshi Rinka
- Emergency and Critical Care Medical CenterOsaka City General HospitalOsakaJapan
| | - Yasuo Ohishi
- Osaka Mishima Emergency Critical Care CenterOsakaJapan
| | - Tomoyoshi Mohri
- Critical Care and Trauma CenterOsaka General Medical CenterOsakaJapan
| | - Masafumi Kishimoto
- Osaka Prefectural Nakakawachi Medical Center of Acute MedicineHigashi‐OsakaJapan
| | - Ryosuke Kawaguchi
- Osaka Prefectural Senshu Critical Care Medical CenterIzumi‐SanoJapan
| | - Kentaro Kajino
- Emergency and Critical Care Medical CenterOsaka Police HospitalOsakaJapan
| | - Tetsuya Yumoto
- Traumatology and Critical Care Medical CenterNational Hospital Organization Osaka National HospitalOsakaJapan
| | - Toshifumi Uejima
- Department of Emergency and Critical Care MedicineKinki University School of MedicineOsaka‐SayamaJapan
| | - Masahiko Nitta
- Department of Emergency MedicineOsaka Medical College HospitalTakatsukiJapan
| | - Tatsuya Nishiuchi
- Department of Critical Care and Emergency MedicineOsaka City University Graduate School of MedicineOsakaJapan
| | - Chizuka Shiokawa
- Osaka Prefectural Council of Emergency Care FacilitiesOsakaJapan
| | - Taro Irisawa
- Department of Traumatology and Acute Critical MedicineOsaka University Graduate School of MedicineOsakaJapan
| | - Osamu Tasaki
- Department of Traumatology and Acute Critical MedicineOsaka University Graduate School of MedicineOsakaJapan
| | - Hiroshi Ogura
- Department of Traumatology and Acute Critical MedicineOsaka University Graduate School of MedicineOsakaJapan
| | - Yasuyuki Kuwagata
- Department of Traumatology and Acute Critical MedicineOsaka University Graduate School of MedicineOsakaJapan
| | - Takeshi Shimazu
- Department of Traumatology and Acute Critical MedicineOsaka University Graduate School of MedicineOsakaJapan
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Yamada T, Shimizu K, Ogura H, Asahara T, Nomoto K, Yamakawa K, Hamasaki T, Nakahori Y, Ohnishi M, Kuwagata Y, Shimazu T. Rapid and Sustained Long-Term Decrease of Fecal Short-Chain Fatty Acids in Critically Ill Patients With Systemic Inflammatory Response Syndrome. JPEN J Parenter Enteral Nutr 2014; 39:569-77. [PMID: 24711120 DOI: 10.1177/0148607114529596] [Citation(s) in RCA: 56] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2013] [Accepted: 03/04/2014] [Indexed: 12/14/2022]
Abstract
BACKGROUND The gut is an important target organ for injury after severe insult. Short-chain fatty acids (SCFAs) are end-products of fermentation of dietary fibers by anaerobic microbiota. They are related to intestinal energy, motility, and transport and to protective effects against infection and inflammation. However, there are few clinical data on SCFAs in critically ill patients. We evaluated serial change in fecal SCFAs in patients with severe systemic inflammatory response syndrome (SIRS). PATIENTS AND METHODS This study included 140 intensive care unit (ICU) patients who fulfilled the criteria of SIRS and had a serum C-reactive protein level of >10 mg/dL. A fecal sample was used for quantitative measurement of fecal SCFA (butyrate, propionate, and acetate) concentrations by high-performance liquid chromatography. Fecal SCFAs were evaluated weekly for 6 weeks after admission. Data obtained from patients were compared with corresponding data from healthy volunteers. RESULTS SIRS resulted from infection in 78 patients, trauma in 30, burns in 12, and other causes in 20. Fecal concentrations of butyrate, propionate, and acetate in these patients decreased significantly compared with those in healthy volunteers and remained low throughout the 6 weeks of the patients' ICU stay. Fecal concentrations of SCFAs in the patients with gastrointestinal complications, including enteritis and dysmotility, were lower than those in the patients without gastrointestinal complications. CONCLUSIONS Concentrations of fecal SCFAs in patients with severe SIRS were significantly lower than those in healthy volunteers over a 6-week period. Maintenance of SCFAs may have therapeutic potential to prevent gastrointestinal complications in critically ill patients.
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Affiliation(s)
- Tomoki Yamada
- Department of Traumatology and Acute Critical Medicine, Osaka University Graduate School, Osaka, Japan
| | - Kentaro Shimizu
- Department of Traumatology and Acute Critical Medicine, Osaka University Graduate School, Osaka, Japan
| | - Hiroshi Ogura
- Department of Traumatology and Acute Critical Medicine, Osaka University Graduate School, Osaka, Japan
| | - Takashi Asahara
- Yakult Central Institute for Microbiological Research, Tokyo, Japan
| | - Koji Nomoto
- Yakult Central Institute for Microbiological Research, Tokyo, Japan
| | - Kazuma Yamakawa
- Department of Traumatology and Acute Critical Medicine, Osaka University Graduate School, Osaka, Japan
| | - Toshimitsu Hamasaki
- Department of Biomedical Statistics, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Yasutaka Nakahori
- Department of Emergency and Critical Care, Osaka General Medical Center, Osaka, Japan
| | - Mitsuo Ohnishi
- Department of Traumatology and Acute Critical Medicine, Osaka University Graduate School, Osaka, Japan
| | - Yasuyuki Kuwagata
- Department of Emergency and Critical Care Medicine, Kansai Medical University, Hirakata-City, Osaka, Japan
| | - Takeshi Shimazu
- Department of Traumatology and Acute Critical Medicine, Osaka University Graduate School, Osaka, Japan
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Iba J, Tasaki O, Hirao T, Mohri T, Yoshiya K, Hayakawa K, Shiozaki T, Hamasaki T, Nakamori Y, Fujimi S, Ogura H, Kuwagata Y, Shimazu T. Outcome prediction model for severe traumatic brain injury. Acute Med Surg 2013; 1:31-36. [PMID: 29930819 DOI: 10.1002/ams2.5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2013] [Accepted: 09/17/2013] [Indexed: 11/07/2022] Open
Abstract
Aim Treatment of severe traumatic brain injury is aided by better prediction of outcomes. The purpose of the present study was to develop and validate a prediction model using retrospective analysis of prospectively collected clinical data from two tertiary critical care medical centers in Japan. Methods Data were collected from 253 patients with a Glasgow Coma Scale score of <9. Within 24 h of their admission, 15 factors possibly related to outcome were evaluated. The dataset was randomly split into training and validation datasets using the repeated random subsampling method. A logistic regression model was fitted to the training dataset and predictive accuracy was assessed using the validation data. Results The best model included the variables age, pupillary light reflex, extensive subarachnoid hemorrhage, intracranial pressure, and midline shift. The estimated area under the curve for the model development data was 0.957, with a 95% confidence interval of 0.926-0.987, and that for validation data was 0.947, with a 95% confidence interval of 0.909-0.980. Conclusion Our predictive model was shown to have high predictive value. It will be useful for review of treatment, family counseling, and efficient allocation of resources for patients with severe traumatic brain injury.
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Affiliation(s)
- Jiro Iba
- Emergency and Critical Care Medical Center Osaka Police Hospital Osaka Japan
| | - Osamu Tasaki
- Department of Emergency Medicine, Unit of Clinical Medicine Nagasaki University Graduate School of Biomedical Sciences Nagasaki Japan
| | - Tomohito Hirao
- Department of Emergency Medicine, Unit of Clinical Medicine Nagasaki University Graduate School of Biomedical Sciences Nagasaki Japan
| | - Tomoyoshi Mohri
- Emergency and Critical Care Center Hyogo Prefectural Nishinomiya Hospital Hyogo Japan
| | - Kazuhisa Yoshiya
- Department of Traumatology and Acute Critical Medicine Osaka University Graduate School of Medicine Osaka Japan
| | - Koichi Hayakawa
- Department of Emergency and Critical Care Medicine Kansai Medical University Hirakata Hospital Osaka Japan
| | - Tadahiko Shiozaki
- Department of Traumatology and Acute Critical Medicine Osaka University Graduate School of Medicine Osaka Japan
| | - Toshimitsu Hamasaki
- Department of Biomedical Statistics Osaka University Graduate School of Medicine Osaka Japan
| | - Yasushi Nakamori
- Department of Emergency and Critical Care Medicine Kansai Medical University Hirakata Hospital Osaka Japan
| | - Satoshi Fujimi
- Department of Emergency and Critical Care Osaka General Medical Center Osaka Japan
| | - Hiroshi Ogura
- Department of Traumatology and Acute Critical Medicine Osaka University Graduate School of Medicine Osaka Japan
| | - Yasuyuki Kuwagata
- Department of Emergency and Critical Care Medicine Kansai Medical University Hirakata Hospital Osaka Japan
| | - Takeshi Shimazu
- Department of Traumatology and Acute Critical Medicine Osaka University Graduate School of Medicine Osaka Japan
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Wada D, Nakamori Y, Yamakawa K, Yoshikawa Y, Kiguchi T, Tasaki O, Ogura H, Kuwagata Y, Shimazu T, Hamasaki T, Fujimi S. Impact on survival of whole-body computed tomography before emergency bleeding control in patients with severe blunt trauma. Crit Care 2013; 17:R178. [PMID: 24025196 PMCID: PMC4057394 DOI: 10.1186/cc12861] [Citation(s) in RCA: 50] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/17/2013] [Indexed: 12/24/2022]
Abstract
Introduction Whole-body computed tomography (CT) has gained importance in the early diagnostic phase of trauma care. However, the diagnostic value of CT for seriously injured patients is not thoroughly clarified. This study assessed whether preoperative CT beneficially affected survival of patients with blunt trauma who required emergency bleeding control. Methods This retrospective study was conducted from January 2004 to December 2010 in two tertiary trauma centers in Japan. The primary inclusion criterion was patients with blunt trauma who required emergency bleeding control (surgery or transcatheter arterial embolization). CT before emergency bleeding control was performed at the attending physician's discretion based on individual patient condition (for example, hemodynamic stability or certain abnormalities in the primary survey). We assessed covariates associated with 28-day mortality with multivariate logistic regression analysis and evaluated standardized mortality ratio (SMR, ratio of observed to predicted mortality by Trauma and Injury Severity Score (TRISS) method) in two subgroups of patients who did or did not undergo CT. Results The inclusion criterion was fulfilled by 152 patients with a median Injury Severity Score of 35.3. During the early resuscitation phase, 132 (87%) patients underwent CT and 20 (13%) did not. Severity of injury was significantly higher in the non-CT versus CT group patients. Observed mortality rate was significantly lower in the CT versus non-CT group (18% vs. 80%, P <0.001). Multivariate adjustment for the probability of survival (Ps) by TRISS method confirmed CT as an independent predictor for 28-day mortality (adjusted OR, 7.22; 95% CI, 1.76 to 29.60; P = 0.006). In the subgroup with less severe trauma (TRISS Ps ≥50%), SMR in the CT group was 0.63 (95% CI, 0.23 to 1.03; P = 0.066), indicating no significant difference between observed and predicted mortality in the CT group. In contrast, in the subgroup with more severe trauma (TRISS Ps <50%), SMR was 0.65 (95% CI, 0.41 to 0.90; P = 0.004) only in the CT group, whereas the difference between observed and predicted mortality was not significant in the non-CT group, suggesting a possible beneficial effect of CT on survival only in trauma patients at high risk of death. Conclusion CT performed before emergency bleeding control might be associated with improved survival, especially in severe trauma patients with TRISS Ps of <50%.
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Yamakawa K, Matsumoto N, Imamura Y, Muroya T, Yamada T, Nakagawa J, Shimazaki J, Ogura H, Kuwagata Y, Shimazu T. Electrical vagus nerve stimulation attenuates systemic inflammation and improves survival in a rat heatstroke model. PLoS One 2013; 8:e56728. [PMID: 23424673 PMCID: PMC3570456 DOI: 10.1371/journal.pone.0056728] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2012] [Accepted: 01/14/2013] [Indexed: 11/21/2022] Open
Abstract
This study was performed to gain insights into novel therapeutic approaches for the treatment of heatstroke. The central nervous system regulates peripheral immune responses via the vagus nerve, the primary neural component of the cholinergic anti-inflammatory pathway. Electrical vagus nerve stimulation (VNS) reportedly suppresses pro-inflammatory cytokine release in several models of inflammatory disease. Here, we evaluated whether electrical VNS attenuates severe heatstroke, which induces a systemic inflammatory response. Anesthetized rats were subjected to heat stress (41.5°C for 30 minutes) with/without electrical VNS. In the VNS-treated group, the cervical vagus nerve was stimulated with constant voltage (10 V, 2 ms, 5 Hz) for 20 minutes immediately after completion of heat stress. Sham-operated animals underwent the same procedure without stimulation under a normothermic condition. Seven-day mortality improved significantly in the VNS-treated group versus control group. Electrical VNS significantly suppressed induction of pro-inflammatory cytokines such as tumor necrosis factor-α and interleukin-6 in the serum 6 hours after heat stress. Simultaneously, the increase of soluble thrombomodulin and E-selectin following heat stress was also suppressed by VNS treatment, suggesting its protective effect on endothelium. Immunohistochemical analysis using tissue preparations obtained 6 hours after heat stress revealed that VNS treatment attenuated infiltration of inflammatory (CD11b-positive) cells in lung and spleen. Interestingly, most cells with increased CD11b positivity in response to heat stress did not express α7 nicotinic acetylcholine receptor in the spleen. These data indicate that electrical VNS modulated cholinergic anti-inflammatory pathway abnormalities induced by heat stress, and this protective effect was associated with improved mortality. These findings may provide a novel therapeutic strategy to combat severe heatstroke in the critical care setting.
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Affiliation(s)
- Kazuma Yamakawa
- Department of Traumatology and Acute Critical Medicine, Osaka University Graduate School of Medicine, Osaka, Japan.
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Yamakawa K, Ogura H, Fujimi S, Morikawa M, Ogawa Y, Mohri T, Nakamori Y, Inoue Y, Kuwagata Y, Tanaka H, Hamasaki T, Shimazu T. Recombinant human soluble thrombomodulin in sepsis-induced disseminated intravascular coagulation: a multicenter propensity score analysis. Intensive Care Med 2013; 39:644-52. [PMID: 23361628 PMCID: PMC3607733 DOI: 10.1007/s00134-013-2822-2] [Citation(s) in RCA: 88] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2012] [Accepted: 12/09/2012] [Indexed: 02/06/2023]
Abstract
Purpose Evidence of efficacy and safety of, and especially mortality related to, recombinant human thrombomodulin (rhTM) treatment for sepsis-induced disseminated intravascular coagulation (DIC) is limited. We hypothesized that patients with sepsis-induced DIC receiving treatment with rhTM would have improved mortality compared with those with similar acuity who did not. Methods This retrospective cohort study conducted in three tertiary referral hospitals in Japan between January 2006 and June 2011 included all patients with sepsis-induced DIC who required ventilator management. Primary endpoint was in-hospital mortality, with duration of intensive care unit treatment, changes in DIC scores and rate of bleeding complications as secondary endpoints. Regression technique was used to develop a propensity model adjusted for baseline imbalances between groups. Results Eligible were 162 patients with sepsis-induced DIC; 68 patients received rhTM and 94 did not. Patients receiving rhTM had higher severity of illness according to baseline characteristics. After adjusting for these imbalances by stratified propensity score analysis, treatment with rhTM was significantly associated with reduced in-hospital mortality (adjusted hazard ratio, 0.45; 95 % confidential interval, 0.26–0.77; p = 0.013). An association between rhTM treatment and higher numbers of intensive care unit-free days, ventilator-free days, and vasopressor-free days were observed. DIC scores were significantly decreased in the rhTM group compared with the control group in the early period after rhTM treatment, whereas the incidence of bleeding-related adverse events did not differ between the two groups. Conclusions Therapy with rhTM may be associated with reduced in-hospital mortality in adult mechanically ventilated patients with sepsis-induced DIC.
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Affiliation(s)
- Kazuma Yamakawa
- Department of Traumatology and Acute Critical Medicine, Osaka University Graduate School of Medicine, 2-15, Yamadaoka, Suita, Osaka, 565-0871, Japan.
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Shimizu K, Ogura H, Irisawa T, Nakagawa Y, Kuwagata Y, Shimazu T. Communicating by electrolarynx with a blind tetraplegic spinal cord injury patient on mechanical ventilation in the ICU. Spinal Cord 2013; 51:341-2. [PMID: 23357929 DOI: 10.1038/sc.2012.170] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
STUDY DESIGN Single-subject case. OBJECTIVES To describe the atypical presentation of communication with a blind tetraplegic spinal cord injury patient on a respirator using an electrolarynx. SETTING Critical care center in Osaka, Japan. METHODS A 53-year-old blind man with tetraplegic spinal cord injury was admitted to our center. It was difficult for him to express his desires and to communicate with others about his severe condition and other details of his care. We began to use an electrolarynx to communicate with this patient because he could move his mouth. RESULTS With use of the electrolarynx, the patient gradually became better able to speak fluently by electrolarynx on the first day of use. The electrolarynx allowed us and his family to communicate with him. He was pleased with the improvement in communication. CONCLUSION An electrolarynx is a useful method for communicating with blind tetraplegic spinal cord injury patients on mechanical ventilation.
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Affiliation(s)
- K Shimizu
- Department of Traumatology and Acute Critical Medicine, Osaka University Graduate School of Medicine, Osaka, Japan.
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Osuka A, Shimizu K, Ogura H, Tasaki O, Hamasaki T, Asahara T, Nomoto K, Morotomi M, Kuwagata Y, Shimazu T. Prognostic impact of fecal pH in critically ill patients. Crit Care 2012; 16:R119. [PMID: 22776285 PMCID: PMC3580696 DOI: 10.1186/cc11413] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/07/2012] [Accepted: 07/10/2012] [Indexed: 01/07/2023]
Abstract
Introduction We have reported that altered gut flora is associated with septic complications and eventual death in critically ill patients with systemic inflammatory response syndrome. It is unclear how fecal pH affects these patients. We sought to determine whether fecal pH can be used as an assessment tool for the clinical course of critically ill patients. Methods Four hundred ninety-one fecal samples were collected from 138 patients who were admitted to the Department of Traumatology and Acute Critical Medicine, Osaka University Graduate School of Medicine, Japan. These patients were treated in the intensive care unit for more than 2 days. Fecal pH, fecal organic acids, and fecal bacteria counts were measured and compared by survived group and nonsurvived group, or nonbacteremia group and bacteremia group. Logistic regression was used to estimate relations between fecal pH, age, sex, or APACHE II score and mortality, and incidence of bacteremia. Differences in fecal organic acids or fecal bacteria counts among acidic, neutral, and alkaline feces were analyzed. Results The increase of fecal pH 6.6 was significantly associated with the increased mortality (odds ratio, 2.46; 95% confidence interval, 1.25 to 4.82) or incidence of bacteremia (3.25; 1.67 to 6.30). Total organic acid was increased in acidic feces and decreased in alkaline feces. Lactic acid, succinic acid, and formic acid were the main contributors to acidity in acidic feces. In alkaline feces, acetic acid was significantly decreased. Propionic acid was markedly decreased in both acidic and alkaline feces compared with neutral feces. No differences were noted among the groups in bacterial counts. Conclusions The data presented here demonstrate that the fecal pH range that extended beyond the normal range was associated with the clinical course and prognosis of critically ill patients.
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Ikegawa H, Kuwagata Y, Hayakawa K, Noguchi K, Ogura H, Sugimoto H. Effects of Exchange Transfusion With Liposome-Encapsulated Hemoglobin on VO2/DO2. Artif Organs 2011; 36:130-8. [DOI: 10.1111/j.1525-1594.2011.01405.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Yamakawa K, Tasaki O, Fukuyama M, Kitayama J, Matsuda H, Nakamori Y, Fujimi S, Ogura H, Kuwagata Y, Hamasaki T, Shimazu T. Assessment of risk factors related to healthcare-associated methicillin-resistant Staphylococcus aureus infection at patient admission to an intensive care unit in Japan. BMC Infect Dis 2011; 11:303. [PMID: 22044716 PMCID: PMC3219579 DOI: 10.1186/1471-2334-11-303] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2011] [Accepted: 11/01/2011] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Healthcare-associated methicillin-resistant Staphylococcus aureus (HA-MRSA) infection in intensive care unit (ICU) patients prolongs ICU stay and causes high mortality. Predicting HA-MRSA infection on admission can strengthen precautions against MRSA transmission. This study aimed to clarify the risk factors for HA-MRSA infection in an ICU from data obtained within 24 hours of patient ICU admission. METHODS We prospectively studied HA-MRSA infection in 474 consecutive patients admitted for more than 2 days to our medical, surgical, and trauma ICU in a tertiary referral hospital in Japan. Data obtained from patients within 24 hours of ICU admission on 11 prognostic variables possibly related to outcome were evaluated to predict infection risk in the early phase of ICU stay. Stepwise multivariate logistic regression analysis was used to identify independent risk factors for HA-MRSA infection. RESULTS Thirty patients (6.3%) had MRSA infection, and 444 patients (93.7%) were infection-free. Intubation, existence of open wound, treatment with antibiotics, and steroid administration, all occurring within 24 hours of ICU admission, were detected as independent prognostic indicators. Patients with intubation or open wound comprised 96.7% of MRSA-infected patients but only 57.4% of all patients admitted. CONCLUSIONS Four prognostic variables were found to be risk factors for HA-MRSA infection in ICU: intubation, open wound, treatment with antibiotics, and steroid administration, all occurring within 24 hours of ICU admission. Preemptive infection control in patients with these risk factors might effectively decrease HA-MRSA infection.
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Affiliation(s)
- Kazuma Yamakawa
- Department of Emergency and Critical Care, Osaka General Medical Center, Osaka, Japan.
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Matsumoto M, Okazaki S, Sakaguchi M, Ohara N, Furukado S, Nagano K, Kuwagata Y, Shimazu T, Yoshimine T, Kitagawa K. Preadmission therapeutic anticoagulation reduces cerebral infarct volume in patients with nonvalvular atrial fibrillation. Eur Neurol 2011; 66:277-82. [PMID: 22025016 DOI: 10.1159/000332037] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2011] [Accepted: 08/13/2011] [Indexed: 11/19/2022]
Abstract
AIM We investigated the influence of preadmission anticoagulation on infarct volume in patients with nonvalvular atrial fibrillation (NVAF). METHODS Data were collected on consecutive ischemic stroke patients with NVAF admitted to Osaka University Hospital between 2004 and 2011. Patients were divided into 3 groups: the no-anticoagulation group, the subtherapeutic anticoagulation group [admission prothrombin time international normalized ratio (PT-INR) <1.6], and the therapeutic anticoagulation group (PT-INR ≥1.6). In analyses of neurological outcome, we excluded patients with a modified Rankin Scale (mRS) score of >1 before onset. RESULTS Of the 68 patients, 45 were classified into the no-anticoagulation group, 9 into the subtherapeutic group, and 14 into the therapeutic group. The median value of infarct volume was 60 (interquartile range 9-176), 142 (64-184), and 8 (3-46) ml in each group, respectively. Infarct volume in the therapeutic group was significantly smaller than in the subtherapeutic group (p = 0.010), and tended to be smaller than in the no-anticoagulation group (p = 0.086). National Institute of Health Stroke Scale score at admission, and mRS score at discharge were significantly reduced in the therapeutic group compared with those in the other groups (p = 0.028 and p = 0.017, respectively). CONCLUSION Therapeutic anticoagulation reduces infarct volume and improves neurological outcome after ischemic stroke in patients with NVAF.
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Affiliation(s)
- Mari Matsumoto
- Stroke Center, Osaka University Graduate School of Medicine, Suita, Osaka, Japan.
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Sakai T, Iwami T, Kitamura T, Nishiyama C, Kawamura T, Kajino K, Tanaka H, Marukawa S, Tasaki O, Shiozaki T, Ogura H, Kuwagata Y, Shimazu T. Global positioning system (GPS) is not an “almighty” but a supportive tool for improving CPR quality. Resuscitation 2011. [DOI: 10.1016/j.resuscitation.2011.03.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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