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Pham T, Heunks L, Bellani G, Madotto F, Aragao I, Beduneau G, Goligher EC, Grasselli G, Laake JH, Mancebo J, Peñuelas O, Piquilloud L, Pesenti A, Wunsch H, van Haren F, Brochard L, Laffey JG, Acharya SP, Amin P, Arabi Y, Aragao I, Bauer P, Beduneau G, Beitler J, Berkius J, Bugedo G, Camporota L, Cerny V, Cho YJ, Clarkson K, Estenssoro E, Goligher E, Grasselli G, Gritsan A, Hashemian SM, Hermans G, Heunks LM, Jovanovic B, Kurahashi K, Laake JH, Matamis D, Moerer O, Molnar Z, Ozyilmaz E, Panka B, Papali A, Peñuelas Ó, Perbet S, Piquilloud L, Qiu H, Razek AA, Rittayamai N, Roldan R, Serpa Neto A, Szuldrzynski K, Talmor D, Tomescu D, Van Haren F, Villagomez A, Zeggwagh AA, Abe T, Aboshady A, Acampo-de Jong M, Acharya S, Adderley J, Adiguzel N, Agrawal VK, Aguilar G, Aguirre G, Aguirre-Bermeo H, Ahlström B, Akbas T, Akker M, Al Sadeh G, Alamri S, Algaba A, Ali M, Aliberti A, Allegue JM, Alvarez D, Amador J, Andersen FH, Ansari S, Apichatbutr Y, Apostolopoulou O, Arabi Y, Arellano D, Arica 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H, Zhang J, Zhang H, Zhang W, Zhang G, Zhang W, Zhao H, Zheng J, Zhu B, Zumaran R. Weaning from mechanical ventilation in intensive care units across 50 countries (WEAN SAFE): a multicentre, prospective, observational cohort study. Lancet Respir Med 2023; 11:465-476. [PMID: 36693401 DOI: 10.1016/s2213-2600(22)00449-0] [Citation(s) in RCA: 24] [Impact Index Per Article: 24.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/09/2022] [Revised: 11/07/2022] [Accepted: 11/10/2022] [Indexed: 01/23/2023]
Abstract
BACKGROUND Current management practices and outcomes in weaning from invasive mechanical ventilation are poorly understood. We aimed to describe the epidemiology, management, timings, risk for failure, and outcomes of weaning in patients requiring at least 2 days of invasive mechanical ventilation. METHODS WEAN SAFE was an international, multicentre, prospective, observational cohort study done in 481 intensive care units in 50 countries. Eligible participants were older than 16 years, admitted to a participating intensive care unit, and receiving mechanical ventilation for 2 calendar days or longer. We defined weaning initiation as the first attempt to separate a patient from the ventilator, successful weaning as no reintubation or death within 7 days of extubation, and weaning eligibility criteria based on positive end-expiratory pressure, fractional concentration of oxygen in inspired air, and vasopressors. The primary outcome was the proportion of patients successfully weaned at 90 days. Key secondary outcomes included weaning duration, timing of weaning events, factors associated with weaning delay and weaning failure, and hospital outcomes. This study is registered with ClinicalTrials.gov, NCT03255109. FINDINGS Between Oct 4, 2017, and June 25, 2018, 10 232 patients were screened for eligibility, of whom 5869 were enrolled. 4523 (77·1%) patients underwent at least one separation attempt and 3817 (65·0%) patients were successfully weaned from ventilation at day 90. 237 (4·0%) patients were transferred before any separation attempt, 153 (2·6%) were transferred after at least one separation attempt and not successfully weaned, and 1662 (28·3%) died while invasively ventilated. The median time from fulfilling weaning eligibility criteria to first separation attempt was 1 day (IQR 0-4), and 1013 (22·4%) patients had a delay in initiating first separation of 5 or more days. Of the 4523 (77·1%) patients with separation attempts, 2927 (64·7%) had a short wean (≤1 day), 457 (10·1%) had intermediate weaning (2-6 days), 433 (9·6%) required prolonged weaning (≥7 days), and 706 (15·6%) had weaning failure. Higher sedation scores were independently associated with delayed initiation of weaning. Delayed initiation of weaning and higher sedation scores were independently associated with weaning failure. 1742 (31·8%) of 5479 patients died in the intensive care unit and 2095 (38·3%) of 5465 patients died in hospital. INTERPRETATION In critically ill patients receiving at least 2 days of invasive mechanical ventilation, only 65% were weaned at 90 days. A better understanding of factors that delay the weaning process, such as delays in weaning initiation or excessive sedation levels, might improve weaning success rates. FUNDING European Society of Intensive Care Medicine, European Respiratory Society.
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Affiliation(s)
- Tài Pham
- Service de Médecine Intensive-Réanimation, AP-HP, Hôpital de Bicêtre, DMU CORREVE, FHU SEPSIS, Groupe de Recherche CARMAS, Hôpitaux Universitaires Paris-Saclay, Le Kremlin-Bicêtre, France; Université Paris-Saclay, UVSQ, Université Paris-Sud, Inserm U1018, Equipe d'Epidémiologie Respiratoire Intégrative, CESP, 94807, Villejuif, France
| | - Leo Heunks
- Department of Intensive Care Medicine, Erasmus University Medical Centre, Rotterdam, The Netherlands
| | - Giacomo Bellani
- School of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy; Department of Emergency and Intensive Care, University Hospital San Gerardo, Monza, Italy
| | - Fabiana Madotto
- Department of Anaesthesia, Intensive Care and Emergency, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Irene Aragao
- Department of Intensive Care Medicine, Centro Hospitalar Universitário do Porto, Porto, Portugal
| | - Gaëtan Beduneau
- Normandie University, UNIROUEN, UR 3830, CHU Rouen, Department of Medical Intensive Care, F-76000 Rouen, France
| | - Ewan C Goligher
- Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, Canada; Department of Medicine, Division of Respirology, Toronto General Hospital Research Institute University Health Network, Toronto, Canada
| | - Giacomo Grasselli
- Department of Anaesthesia, Intensive Care and Emergency, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy; Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
| | - Jon Henrik Laake
- Department of Anaesthesiology and Department of Research and Development, Division of Critical Care and Emergencies, Oslo University Hospital, Oslo, Norway
| | - Jordi Mancebo
- Department of Intensive Care Medicine, Hospital Universitari Sant Pau, Barcelona, Spain
| | - Oscar Peñuelas
- Intensive Care Unit, Hospital Universitario de Getafe, Madrid, Spain; Centro de Investigación Biomédica en Red, CIBER de Enfermedades Respiratorias, CIBERES, Madrid, Spain
| | - Lise Piquilloud
- Adult Intensive Care Unit, University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Antonio Pesenti
- Department of Anaesthesia, Intensive Care and Emergency, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy; Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
| | - Hannah Wunsch
- Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, Canada; Department of Critical Care Medicine, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - Frank van Haren
- College of Health and Medicine, Australian National University, Canberra, ACT, Australia; Intensive Care Unit, St George Hospital, Sydney, NSW, Australia
| | - Laurent Brochard
- Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, Canada; Keenan Research Centre for Biomedical Science, Li Ka Shing Knowledge Institute, St Michael's Hospital, Unity Health Toronto, Toronto, ON, Canada
| | - John G Laffey
- Anaesthesia and Intensive Care Medicine, School of Medicine, Clinical Sciences Institute, Galway University Hospitals, Galway, Ireland; School of Medicine, Regenerative Medicine Institute (REMEDI) at CÚRAM Centre for Research in Medical Devices, National University of Ireland Galway, Galway, Ireland.
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Hasegawa TM, Itagaki T, Sakai S. Intraspecific variation in morphology of spiny pollen grains along an altitudinal gradient in an insect-pollinated shrub. Plant Biol (Stuttg) 2023; 25:287-295. [PMID: 36440587 DOI: 10.1111/plb.13493] [Citation(s) in RCA: 1] [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] [Subscribe] [Scholar Register] [Received: 08/26/2022] [Accepted: 11/15/2022] [Indexed: 06/16/2023]
Abstract
Intraspecific variations in pollen morphological traits are poorly studied. Interspecific variations are often associated with pollination systems and pollinator types. Altitudinal environmental changes, which can influence local pollinator assemblages, provide opportunities to explore differentiation in pollen traits of a single species over short distances. The aim of this study is to examine intraspecific variations in pollen traits of an insect-pollinated shrub, Weigela hortensis (Caprifoliaceae), along an altitudinal gradient. Pollen spine phenotypes (length, number and density), pollen diameter, lipid mass (pollenkitt) around pollen grains, pollen production per flower and pollinator assemblages were compared at four sites at different altitudes. Spine length and the spine length/diameter ratio of pollen grains were greater at higher altitudes but not correlated with flower or plant size. Spine number and density increased as flower size increased, and pollen lipid mass decreased as plant size increased. Bees were the predominant pollinators at low-altitude sites whereas flies, specifically Oligoneura spp. (Acroceridae), increased in relative abundance with increasing altitude. The results of this study suggest that the increase in spine length with altitude was the result of selection favouring longer spines at higher-altitude sites and/or shorter spines at lower-altitude sites. The altitudinal variation in selection pressure on spine length could reflect changes in local pollinator assemblages with altitude.
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Affiliation(s)
- T M Hasegawa
- Graduate School of Life Sciences, Tohoku University, Aoba, Sendai, Japan
| | - T Itagaki
- Graduate School of Life Sciences, Tohoku University, Aoba, Sendai, Japan
| | - S Sakai
- Graduate School of Life Sciences, Tohoku University, Aoba, Sendai, Japan
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3
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Nakano Y, Ueno Y, Ishitani E, Sato K, Sato H, Momota K, Bando N, Akimoto Y, Nunomura T, Ishihara M, Tane N, Itagaki T, Kitamura Y, Oto J. Repetitive postoperative extubation failure due to dynamic inspiratory airway collapse concomitant with subglottic stenosis in a patient who previously underwent tracheostomy. J Med Invest 2023; 70:301-305. [PMID: 37164740 DOI: 10.2152/jmi.70.301] [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] [Indexed: 05/12/2023]
Abstract
BACKGROUND This report describes a case of dynamic inspiratory airway collapse concomitant with subglottic stenosis in a patient who previously underwent tracheostomy that led to repeated post-operative extubation failure. CASE PRESENTATION A 43-year-old woman who had undergone tracheostomy 25 years previously was admitted to our intensive-care unit (ICU) after coronary artery bypass graft surgery. On postoperative day (POD) 0, she was extubated, but stridor was observed. We suspected upper airway obstruction and she was therefore reintubated. Before reintubation, urgent laryngotracheoscopy revealed dynamic inspiratory airway collapse and obstruction concomitant with subglottic stenosis. Preoperative computed tomography showed mild subglottic stenosis. Although intravenous corticosteroids were administered to prevent tracheal mucosal edema and a cuff leak test was confirmed to be negative, she developed extubation failure on POD6. On POD12, we performed tracheostomy to reduce mechanical irritation from the endotracheal tube. Mechanical ventilation was withdrawn and she discharged from the ICU. On POD33, her tracheostomy tube was removed and she remained clinically asymptomatic. CONCLUSIONS We should be aware of the history of tracheostomy, especially at high tracheostomy sites, even in the absence of respiratory symptoms as risk factors for dynamic inspiratory airway collapse concomitant with subglottic stenosis contributing to repeated respiratory failure after extubation. J. Med. Invest. 70 : 301-305, February, 2023.
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Affiliation(s)
- Yuki Nakano
- Emergency Department, Tokushima Prefectural Miyoshi Hospital, 815-2, Miyoshi, Tokushima, 778-8503, Japan
| | - Yoshitoyo Ueno
- Emergency and Critical Care Medicine, Tokushima University Hospital, 2-50-1, Kuramoto, Tokushima, 770-8503, Japan
| | - Emi Ishitani
- Otolaryngology, Tokushima University Graduate School of Biomedical Sciences, 3-18-15, Kuramoto, Tokushima, 770-8503, Japan
| | - Koji Sato
- Emergency and Critical Care Medicine, Tokushima University Hospital, 2-50-1, Kuramoto, Tokushima, 770-8503, Japan
| | - Hiroki Sato
- Emergency and Disaster Medicine, Tokushima University Hospital, 2-50-1, Kuramoto, Tokushima, 770-8503, Japan
| | - Kazuki Momota
- Emergency and Critical Care Medicine, Tokushima University Hospital, 2-50-1, Kuramoto, Tokushima, 770-8503, Japan
| | - Natsuki Bando
- Emergency and Critical Care Medicine, Tokushima University Hospital, 2-50-1, Kuramoto, Tokushima, 770-8503, Japan
| | - Yusuke Akimoto
- Emergency Department, Tokushima Prefectural Miyoshi Hospital, 815-2, Miyoshi, Tokushima, 778-8503, Japan
| | - Toshiyuki Nunomura
- Emergency and Disaster Medicine, Tokushima University Hospital, 2-50-1, Kuramoto, Tokushima, 770-8503, Japan
| | - Manabu Ishihara
- Emergency and Critical Care Medicine, Tokushima University Graduate School of Biomedical Sciences, 3-18-15, Kuramoto, Tokushima, 770-8503, Japan
| | - Natsuki Tane
- Emergency and Critical Care Medicine, Tokushima University Graduate School of Biomedical Sciences, 3-18-15, Kuramoto, Tokushima, 770-8503, Japan
| | - Taiga Itagaki
- Emergency and Disaster Medicine, Tokushima University Hospital, 2-50-1, Kuramoto, Tokushima, 770-8503, Japan
| | - Yoshiaki Kitamura
- Otolaryngology, Tokushima University Graduate School of Biomedical Sciences, 3-18-15, Kuramoto, Tokushima, 770-8503, Japan
| | - Jun Oto
- Emergency and Critical Care Medicine, Tokushima University Graduate School of Biomedical Sciences, 3-18-15, Kuramoto, Tokushima, 770-8503, Japan
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4
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Itagaki T, Akimoto Y, Nakano Y, Ueno Y, Ishihara M, Tane N, Tsunano Y, Oto J. Relationships between double cycling and inspiratory effort with diaphragm thickness during the early phase of mechanical ventilation: A prospective observational study. PLoS One 2022; 17:e0273173. [PMID: 35976965 PMCID: PMC9385032 DOI: 10.1371/journal.pone.0273173] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2021] [Accepted: 08/03/2022] [Indexed: 11/23/2022] Open
Abstract
Background Increased and decreased diaphragm thickness during mechanical ventilation is associated with poor outcomes. Some types of patient-ventilator asynchrony theoretically cause myotrauma of the diaphragm. However, the effects of double cycling on structural changes in the diaphragm have not been previously evaluated. Hence, this study aimed to investigate the relationship between double cycling during the early phase of mechanical ventilation and changes in diaphragm thickness, and the involvement of inspiratory effort in the occurrence of double cycling. Methods We evaluated adult patients receiving invasive mechanical ventilation for more than 48 h. The end-expiratory diaphragm thickness (Tdiee) was assessed via ultrasonography on days 1, 2, 3, 5 and 7 after the initiation of mechanical ventilation. Then, the maximum rate of change from day 1 (ΔTdiee%) was evaluated. Concurrently, we recorded esophageal pressure and airway pressure on days 1, 2 and 3 for 1 h during spontaneous breathing. Then, the waveforms were retrospectively analyzed to calculate the incidence of double cycling (double cycling index) and inspiratory esophageal pressure swing (ΔPes). Finally, the correlation between double cycling index as well as ΔPes and ΔTdiee% was investigated using linear regression models. Results In total, 19 patients with a median age of 69 (interquartile range: 65–78) years were enrolled in this study, and all received pressure assist-control ventilation. The Tdiee increased by more than 10% from baseline in nine patients, decreased by more than 10% in nine and remained unchanged in one. The double cycling indexes on days 1, 2 and 3 were 2.2%, 1.3% and 4.5%, respectively. There was a linear correlation between the double cycling index on day 3 and ΔTdiee% (R2 = 0.446, p = 0.002). The double cycling index was correlated with the ΔPes on days 2 (R2 = 0.319, p = 0.004) and 3 (R2 = 0.635, p < 0.001). Conclusions Double cycling on the third day of mechanical ventilation was associated with strong inspiratory efforts and, possibly, changes in diaphragm thickness.
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Affiliation(s)
- Taiga Itagaki
- Department of Emergency and Disaster Medicine, Tokushima University Hospital, Tokushima, Japan
- * E-mail:
| | - Yusuke Akimoto
- Department of Emergency and Critical Care Medicine, Tokushima University Hospital, Tokushima, Japan
| | - Yuki Nakano
- Department of Emergency and Critical Care Medicine, Tokushima University Hospital, Tokushima, Japan
| | - Yoshitoyo Ueno
- Department of Emergency and Critical Care Medicine, Tokushima University Hospital, Tokushima, Japan
| | - Manabu Ishihara
- Department of Emergency and Critical Care Medicine, Tokushima University Hospital, Tokushima, Japan
| | - Natsuki Tane
- Department of Emergency and Critical Care Medicine, Tokushima University Graduate School, Tokushima, Japan
| | - Yumiko Tsunano
- Department of Emergency and Critical Care Medicine, Tokushima University Graduate School, Tokushima, Japan
| | - Jun Oto
- Department of Emergency and Critical Care Medicine, Tokushima University Graduate School, Tokushima, Japan
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Ueno Y, Harada S, Sato K, Momota K, Sato H, Akimoto Y, Arai Y, Nunomura T, Ishihara M, Tane N, Itagaki T, Nishioka Y, Oto J. Independent lung ventilation for the management of acute allograft rejection after single-lung transplantation for end-stage emphysema. J Med Invest 2022; 69:323-327. [DOI: 10.2152/jmi.69.323] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Affiliation(s)
- Yoshitoyo Ueno
- Emergency and Critical Care Medicine, Tokushima University Hospital, 2-50-1, Kuramoto, Tokushima, 770-8503, Japan
| | - Saki Harada
- Department of Respiratory Medicine and Rheumatology, Tokushima University Hospital, 2-50-1, Kuramoto, Tokushima, 770-8503, Japan
| | - Koji Sato
- Emergency and Critical Care Medicine, Tokushima University Hospital, 2-50-1, Kuramoto, Tokushima, 770-8503, Japan
| | - Kazuki Momota
- Emergency and Critical Care Medicine, Tokushima University Hospital, 2-50-1, Kuramoto, Tokushima, 770-8503, Japan
| | - Hiroki Sato
- Emergency and Critical Care Medicine, Tokushima University Hospital, 2-50-1, Kuramoto, Tokushima, 770-8503, Japan
| | - Yusuke Akimoto
- Emergency and Critical Care Medicine, Tokushima University Graduate School of Biomedical Sciences, 3-18-15, Kuramoto, Tokushima, 770-8503, Japan
| | - Yuta Arai
- Emergency and Disaster Medicine, Tokushima University Hospital, 2-50-1, Kuramoto, Tokushima, 770-8503, Japan
| | - Toshiyuki Nunomura
- Emergency and Disaster Medicine, Tokushima University Hospital, 2-50-1, Kuramoto, Tokushima, 770-8503, Japan
| | - Manabu Ishihara
- Emergency and Critical Care Medicine, Tokushima University Graduate School of Biomedical Sciences, 3-18-15, Kuramoto, Tokushima, 770-8503, Japan
| | - Natsuki Tane
- Emergency and Critical Care Medicine, Tokushima University Graduate School of Biomedical Sciences, 3-18-15, Kuramoto, Tokushima, 770-8503, Japan
| | - Taiga Itagaki
- Emergency and Disaster Medicine, Tokushima University Hospital, 2-50-1, Kuramoto, Tokushima, 770-8503, Japan
| | - Yasuhiko Nishioka
- Department of Respiratory Medicine and Rheumatology, Tokushima University Graduate School of Biomedical Sciences, 3-18-15, Kuramoto, Tokushima, 770-8503, Japan
| | - Jun Oto
- Emergency and Critical Care Medicine, Tokushima University Graduate School of Biomedical Sciences, 3-18-15, Kuramoto, Tokushima, 770-8503, Japan
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6
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Akimoto Y, Bando N, Sato H, Sato K, Momota K, Nunomura T, Ueno Y, Ishihara M, Tane N, Itagaki T, Oto J. Acquired laryngomalacia as a cause of post-extubation respiratory failure in patient with postoperative seizure and central pontine myelinolysis after craniotomy. J Med Invest 2022; 69:316-319. [DOI: 10.2152/jmi.69.316] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Affiliation(s)
- Yusuke Akimoto
- Emergency and Critical Care Medicine, Tokushima University Graduate School of Biomedical Sciences, Tokushima, Japan
| | - Natsuki Bando
- Emergency and Critical Care Medicine, Tokushima University Hospital, Tokushima, Japan
| | - Hiroki Sato
- Emergency and Critical Care Medicine, Tokushima University Hospital, Tokushima, Japan
| | - Koji Sato
- Emergency and Critical Care Medicine, Tokushima University Hospital, Tokushima, Japan
| | - Kazuki Momota
- Emergency and Critical Care Medicine, Tokushima University Hospital, Tokushima, Japan
| | - Toshiyuki Nunomura
- Emergency and Disaster Medicine, Tokushima University Hospital, Tokushima, Japan
| | - Yoshitoyo Ueno
- Emergency and Critical Care Medicine, Tokushima University Hospital, Tokushima, Japan
| | - Manabu Ishihara
- Emergency and Critical Care Medicine, Tokushima University Hospital, Tokushima, Japan
| | - Natsuki Tane
- Emergency and Critical Care Medicine, Tokushima University Graduate School of Biomedical Sciences, Tokushima, Japan
| | - Taiga Itagaki
- Emergency and Disaster Medicine, Tokushima University Hospital, Tokushima, Japan
| | - Jun Oto
- Emergency and Critical Care Medicine, Tokushima University Graduate School of Biomedical Sciences, Tokushima, Japan
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Ueno Y, Sato K, Momota K, Sato H, Nakano Y, Akimoto Y, Nunomura T, Tane N, Itagaki T, Oto J. The quality and quantity of sleep on dexmedetomidine during high-flow nasal cannula oxygen therapy in critically ill patients. J Med Invest 2022; 69:266-272. [DOI: 10.2152/jmi.69.266] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Affiliation(s)
- Yoshitoyo Ueno
- Emergency and Critical Care Medicine, Tokushima University Hospital, 2-50-1, Kuramoto, Tokushima, 770-8503, Japan
| | - Koji Sato
- Emergency and Critical Care Medicine, Tokushima University Hospital, 2-50-1, Kuramoto, Tokushima, 770-8503, Japan
| | - Kazuki Momota
- Emergency and Critical Care Medicine, Tokushima University Hospital, 2-50-1, Kuramoto, Tokushima, 770-8503, Japan
| | - Hiroki Sato
- Emergency and Critical Care Medicine, Tokushima University Hospital, 2-50-1, Kuramoto, Tokushima, 770-8503, Japan
| | - Yuki Nakano
- Emergency and Critical Care Medicine, Tokushima Prefectural Miyoshi Hospital, 815-2, Ikeda-cho Shima, Miyoshi, 778-8503, Japan
| | - Yusuke Akimoto
- Emergency and Critical Care Medicine, Tokushima University Graduate School of Biomedical Sciences, 3-18-15, Kuramoto, Tokushima, 770-8503, Japan
| | - Toshiyuki Nunomura
- Emergency and Disaster Medicine, Tokushima University Hospital, 2-50-1, Kuramoto, Tokushima, 770-8503, Japan
| | - Natsuki Tane
- Emergency and Critical Care Medicine, Tokushima University Graduate School of Biomedical Sciences, 3-18-15, Kuramoto, Tokushima, 770-8503, Japan
| | - Taiga Itagaki
- Emergency and Disaster Medicine, Tokushima University Hospital, 2-50-1, Kuramoto, Tokushima, 770-8503, Japan
| | - Jun Oto
- Emergency and Critical Care Medicine, Tokushima University Graduate School of Biomedical Sciences, 3-18-15, Kuramoto, Tokushima, 770-8503, Japan
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Itagaki T. Diaphragm-protective mechanical ventilation in acute respiratory failure. J Med Invest 2022; 69:165-172. [DOI: 10.2152/jmi.69.165] [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: 03/30/2023]
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Nakanishi N, Suzuki Y, Ishihara M, Ueno Y, Tane N, Tsunano Y, Itagaki T, Oto J. Effect of High-Flow Nasal Cannula on Sleep-disordered Breathing and Sleep Quality in Patients With Acute Stroke. Cureus 2020; 12:e9303. [PMID: 32832300 PMCID: PMC7437095 DOI: 10.7759/cureus.9303] [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] [Indexed: 11/25/2022] Open
Abstract
Introduction Sleep-disordered breathing (SDB) is common after stroke. Although the standard treatment of SDB is continuous positive airway pressure (CPAP) ventilation, the patient’s intolerance and discomfort result in low adherence rates. Alternatively, high-flow nasal cannula (HFNC) may be useful as it reduces upper airway collapse with low level of positive pressure and well tolerability. The aim of this study was to investigate whether HFNC therapy reduces SDB and improves sleep quality with higher compliance rate. Methods We included acute stroke patients with SDB for the assessment of apnea-hypopnea index (AHI) >5/h using WatchPAT 200 (Itamar Medical Ltd, Caesarea, Israel). Patients who met inclusion criteria received HFNC therapy (40 L/min) with monitoring by WatchPAT. AHI, oxygen desaturation index (ODI), sleep efficiency, and rapid eye movement (REM) sleep were compared in patients with and without HFNC therapy. We also evaluated the patient’s comfort of HFNC therapy (discomfort or not). Results Among 17 patients assessed for AHI, 12 received HFNC therapy. HFNC therapy was not adhered in two patients due to intolerance. Eight patients remained for final analysis. There were no differences in SDB and sleep quality with and without HFNC therapy as follows: HFNC therapy vs control; AHI 24.9 ± 20.1 vs 21.3 ± 15.0/h (p = 0.63), ODI 16.2 ± 16.5 vs 12.9 ± 12.3/h (p = 0.54), sleep efficiency 80.4 ± 12.9 vs 87.1 ± 6.2 (p = 0.28), percentage of REM sleep 19.4% ± 9.6% vs 27.6% ± 8.9% (p = 0.07). Two patients (17%) complained of discomfort among eight patients. Conclusion HFNC therapy did not improve SDB and sleep quality. Nonadherence and discomfort were observed in HFNC therapy. We need a large trial to confirm this result.
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Affiliation(s)
- Nobuto Nakanishi
- Emergency and Critical Care Medicine, Tokushima University Hospital, Tokushima, JPN
| | - Yasuhiro Suzuki
- Emergency and Critical Care Center, Kurashiki Central Hospital, Kurashiki, JPN
| | - Manabu Ishihara
- Emergency and Critical Care Medicine, Tokushima University Hospital, Tokushima, JPN
| | - Yoshitoyo Ueno
- Emergency and Critical Care Medicine, Tokushima University Hospital, Tokushima, JPN
| | - Natsuki Tane
- Emergency and Disaster Medicine, Tokushima University Hospital, Tokushima, JPN
| | - Yumiko Tsunano
- Emergency and Critical Care Medicine, Tokushima University Hospital, Tokushima, JPN
| | - Taiga Itagaki
- Emergency and Critical Care Medicine, Tokushima University Hospital, Tokushima, JPN
| | - Jun Oto
- Emergency and Critical Care Medicine, Tokushima University Hospital, Tokushima, JPN
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Itagaki T, Nakanishi N, Takashima T, Ueno Y, Tane N, Tsunano Y, Nunomura T, Oto J. Effect of controlled ventilation during assist-control ventilation on diaphragm thickness : a post hoc analysis of an observational study. J Med Invest 2020; 67:332-337. [PMID: 33148911 DOI: 10.2152/jmi.67.332] [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] [Indexed: 11/14/2022]
Abstract
Background : Since diaphragm passivity induces oxidative stress that leads to rapid atrophy of diaphragm, we investigated the effect of controlled ventilation on diaphragm thickness during assist-control ventilation (ACV). Methods : Previously, we measured end-expiratory diaphragm thickness (Tdiee) of patients mechanically ventilated for more than 48 hours on days 1, 3, 5 and 7 after the start of ventilation. We retrospectively investigated the proportion of controlled ventilation during the initial 48-hour ACV (CV48%). Patients were classified according to CV48% : Low group, less than 25% ; High group, higher than 25%. Results : Of 56 patients under pressure-control ACV, Tdiee increased more than 10% in 6 patients (11%), unchanged in 8 patients (14%) and decreased more than 10% in 42 patients (75%). During the first week of ventilation, Tdiee decreased in both groups : Low (difference, -7.4% ; 95% confidence interval [CI], -10.1% to -4.6% ; p < 0.001) and High group (difference, -5.2% ; 95% CI, -8.5% to -2.0% ; p = 0.049). Maximum Tdiee variation from baseline did not differ between Low (-15.8% ; interquartile range [IQR], -22.3 to -1.5) and High group (-16.7% ; IQR, -22.6 to -11.1, p = 0.676). Conclusions : During ACV, maximum variation in Tdiee was not associated with proportion of controlled ventilation higher than 25%. J. Med. Invest. 67 : 332-337, August, 2020.
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Affiliation(s)
- Taiga Itagaki
- Department of Emergency and Critical Care Medicine, Tokushima University Graduate School, Tokushima, Japan
| | - Nobuto Nakanishi
- Department of Emergency and Critical Care Medicine, Tokushima University Graduate School, Tokushima, Japan
| | - Takuya Takashima
- Department of Emergency and Critical Care Medicine, Tokushima University Hospital, Tokushima, Japan
| | - Yoshitoyo Ueno
- Department of Emergency and Critical Care Medicine, Tokushima University Hospital, Tokushima, Japan
| | - Natsuki Tane
- Department of Emergency and Disaster Medicine, Tokushima University Hospital, Tokushima, Japan
| | - Yumiko Tsunano
- Department of Emergency and Critical Care Medicine, Tokushima University Graduate School, Tokushima, Japan
| | - Toshiyuki Nunomura
- Division of Critical Care Center, Kochi Red Cross Hospital, Kochi, Japan
| | - Jun Oto
- Department of Emergency and Disaster Medicine, Tokushima University Hospital, Tokushima, Japan
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11
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Nakanishi N, Tsutsumi R, Okayama Y, Takashima T, Ueno Y, Itagaki T, Tsutsumi Y, Sakaue H, Oto J. Monitoring of muscle mass in critically ill patients: comparison of ultrasound and two bioelectrical impedance analysis devices. J Intensive Care 2019; 7:61. [PMID: 31890223 PMCID: PMC6916000 DOI: 10.1186/s40560-019-0416-y] [Citation(s) in RCA: 50] [Impact Index Per Article: 10.0] [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: 05/16/2019] [Accepted: 11/21/2019] [Indexed: 12/11/2022] Open
Abstract
Background Skeletal muscle atrophy commonly occurs in critically ill patients, and decreased muscle mass is associated with worse clinical outcomes. Muscle mass can be assessed using various tools, including ultrasound and bioelectrical impedance analysis (BIA). However, the effectiveness of muscle mass monitoring is unclear in critically ill patients. This study was conducted to compare ultrasound and BIA for the monitoring of muscle mass in critically ill patients. Methods We recruited adult patients who were expected to undergo mechanical ventilation for > 48 h and to remain in the intensive care unit (ICU) for > 5 days. On days 1, 3, 5, 7, and 10, muscle mass was evaluated using an ultrasound and two BIA devices (Bioscan: Malton International, England; Physion: Nippon Shooter, Japan). The influence of fluid balance was also evaluated between each measurement day. Results We analyzed 93 images in 21 patients. The age of the patients was 69 (interquartile range, IQR, 59–74) years, with 16 men and 5 women. The length of ICU stay was 11 days (IQR, 9–25 days). The muscle mass, monitored by ultrasound, decreased progressively by 9.2% (95% confidence interval (CI), 5.9–12.5%), 12.7% (95% CI, 9.3–16.1%), 18.2% (95% CI, 14.7–21.6%), and 21.8% (95% CI, 17.9–25.7%) on days 3, 5, 7, and 10 (p < 0.01), respectively, with no influence of fluid balance (r = 0.04, p = 0.74). The muscle mass did not decrease significantly in both the BIA devices (Bioscan, p = 0.14; Physion, p = 0.60), and an influence of fluid balance was observed (Bioscan, r = 0.37, p < 0.01; Physion, r = 0.51, p < 0.01). The muscle mass assessment at one point between ultrasound and BIA was moderately correlated (Bioscan, r = 0.51, p < 0.01; Physion, r = 0.37, p < 0.01), but the change of muscle mass in the same patient did not correlate between these two devices (Bioscan, r = − 0.05, p = 0.69; Physion, r = 0.23, p = 0.07). Conclusions Ultrasound is suitable for sequential monitoring of muscle atrophy in critically ill patients. Monitoring by BIA should be carefully interpreted owing to the influence of fluid change. Trial registration UMIN000031316. Retrospectively registered on 15 February 2018.
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Affiliation(s)
- Nobuto Nakanishi
- 1Emergency and Critical Care Medicine, Tokushima University Hospital, 2-50-1 Kuramoto, Tokushima, 770-8503 Japan
| | - Rie Tsutsumi
- 2Department of Nutrition and Metabolism, Tokushima University Graduate School of Biomedical Sciences, 3-18-15 Kuramoto, Tokushima, 770-8503 Japan
| | - Yoshihiro Okayama
- 3Clinical Trial Center for Developmental therapeutics, Tokushima University Hospital, 2-50-1 Kuramoto, Tokushima, 770-8503 Japan
| | - Takuya Takashima
- 1Emergency and Critical Care Medicine, Tokushima University Hospital, 2-50-1 Kuramoto, Tokushima, 770-8503 Japan
| | - Yoshitoyo Ueno
- 1Emergency and Critical Care Medicine, Tokushima University Hospital, 2-50-1 Kuramoto, Tokushima, 770-8503 Japan
| | - Taiga Itagaki
- 1Emergency and Critical Care Medicine, Tokushima University Hospital, 2-50-1 Kuramoto, Tokushima, 770-8503 Japan
| | - Yasuo Tsutsumi
- 4Department of Anesthesiology and Critical Care, Hiroshima University, 1-2-3 Kasumi, Hiroshima, 734-8551 Japan
| | - Hiroshi Sakaue
- 2Department of Nutrition and Metabolism, Tokushima University Graduate School of Biomedical Sciences, 3-18-15 Kuramoto, Tokushima, 770-8503 Japan
| | - Jun Oto
- 5Emergency and Disaster Medicine, Tokushima University Hospital, 2-50-1 Kuramoto, Tokushima, 770-8503 Japan
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Nakanishi N, Oto J, Ueno Y, Nakataki E, Itagaki T, Nishimura M. Change in diaphragm and intercostal muscle thickness in mechanically ventilated patients: a prospective observational ultrasonography study. J Intensive Care 2019; 7:56. [PMID: 31827804 PMCID: PMC6886193 DOI: 10.1186/s40560-019-0410-4] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [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: 06/10/2019] [Accepted: 10/17/2019] [Indexed: 11/15/2022] Open
Abstract
Background Diaphragm atrophy is observed in mechanically ventilated patients. However, the atrophy is not investigated in other respiratory muscles. Therefore, we conducted a two-center prospective observational study to evaluate changes in diaphragm and intercostal muscle thickness in mechanically ventilated patients. Methods Consecutive adult patients who were expected to be mechanically ventilated longer than 48 h in the ICU were enrolled. Diaphragm and intercostal muscle thickness were measured on days 1, 3, 5, and 7 with ultrasonography. The primary outcome was the direction of change in muscle thickness, and the secondary outcomes were the relationship of changes in muscle thickness with patient characteristics. Results Eighty patients (54 males and 26 females; mean age, 68 ± 14 years) were enrolled. Diaphragm muscle thickness decreased, increased, and remained unchanged in 50 (63%), 15 (19%), and 15 (19%) patients, respectively. Intercostal muscle thickness decreased, increased, and remained unchanged in 48 (60%), 15 (19%), and 17 (21%) patients, respectively. Decreased diaphragm or intercostal muscle thickness was associated with prolonged mechanical ventilation (median difference (MD), 3 days; 95% CI (confidence interval), 1–7 and MD, 3 days; 95% CI, 1–7, respectively) and length of ICU stay (MD, 3 days; 95% CI, 1–7 and MD, 3 days; 95% CI, 1–7, respectively) compared with the unchanged group. After adjusting for sex, age, and APACHE II score, they were still associated with prolonged mechanical ventilation (hazard ratio (HR), 4.19; 95% CI, 2.14–7.93 and HR, 2.87; 95% CI, 1.53–5.21, respectively) and length of ICU stay (HR, 3.44; 95% CI, 1.77–6.45 and HR, 2.58; 95% CI, 1.39–4.63, respectively) compared with the unchanged group. Conclusions Decreased diaphragm and intercostal muscle thickness were frequently seen in patients under mechanical ventilation. They were associated with prolonged mechanical ventilation and length of ICU stay. Trial registration UMIN000031316. Registered on 15 February 2018
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Affiliation(s)
- Nobuto Nakanishi
- 1Emergency and Critical Care Medicine, Tokushima University Hospital, 2-50-1 Kuramoto, Tokushima, 770-8503 Japan
| | - Jun Oto
- 1Emergency and Critical Care Medicine, Tokushima University Hospital, 2-50-1 Kuramoto, Tokushima, 770-8503 Japan
| | - Yoshitoyo Ueno
- 1Emergency and Critical Care Medicine, Tokushima University Hospital, 2-50-1 Kuramoto, Tokushima, 770-8503 Japan
| | - Emiko Nakataki
- 2Tokushima Prefectural Central Hospital, 1-10-3 Kuramoto, Tokushima, 770-8539 Japan
| | - Taiga Itagaki
- 1Emergency and Critical Care Medicine, Tokushima University Hospital, 2-50-1 Kuramoto, Tokushima, 770-8503 Japan
| | - Masaji Nishimura
- 2Tokushima Prefectural Central Hospital, 1-10-3 Kuramoto, Tokushima, 770-8539 Japan
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13
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Sasada S, Masumoto N, Nishina M, Kimura Y, Amioka A, Itagaki T, Emi A, Kadoya T, Okada M. Classification of abnormal findings on ring-type dedicated breast PET for detecting breast cancer. Ann Oncol 2019. [DOI: 10.1093/annonc/mdz257.025] [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: 11/14/2022] Open
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14
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Masumoto N, Kadoya T, Nishina M, Kimura Y, Amioka A, Itagaki T, Sasada S, Emi A, Okada M. Ring-like uptake appearance on dedicated breast positron emission tomography before chemotherapy predicts outcome of neoadjuvant chemotherapy in breast cancer. Ann Oncol 2019. [DOI: 10.1093/annonc/mdz240.102] [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: 11/14/2022] Open
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15
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Onodera M, Nakataki E, Nakanishi N, Itagaki T, Sato M, Oto J, Nishimura M. Bacterial Contamination of Circuit Inner Surfaces After High-Flow Oxygen Therapy. Respir Care 2019; 64:545-549. [PMID: 30723170 DOI: 10.4187/respcare.06299] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND During high-flow oxygen therapy, heated humidified gas is delivered at high flow. Although the warmth and humidity of this gas facilitates mucociliary function in the lower airway, warm and humid conditions also promote bacterial growth. Bacterial contamination of high-flow oxygen therapy circuits has not been well investigated. We examined the incidence of bacterial contamination in high-flow oxygen therapy circuits. METHODS This was a prospective observational study in a university hospital 10-bed general ICU. After final high-flow oxygen therapy discontinuation, samples were obtained from the interface and the chamber ends of the circuit. Initially, a half circumference of each inner surface was swabbed, after which the whole circuit was left in the ICU at room temperature for 6 h. The samples were then, in the same way, taken from the previously unswabbed arcs of the end inner surfaces. All the samples were sent to a biology laboratory and cultured. RESULTS In all, 118 samples were collected from 31 circuits. The median duration of high-flow oxygen therapy was 48 h (interquartile range, 26-96 h). Of 31 circuits, contamination occurred in 5 circuits (16.1% [95% CI 5.5-33.7%]). CONCLUSIONS Bacterial contamination of inner surfaces of the circuit after high-flow oxygen therapy was relatively high.
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Affiliation(s)
- Mutsuo Onodera
- Emergency and Critical Care Medicine, Tokushima University Graduate School, Tokushima, Japan
| | - Emiko Nakataki
- Emergency and Critical Care Medicine, Tokushima University Graduate School, Tokushima, Japan
| | - Nobuto Nakanishi
- Emergency and Critical Care Medicine, Tokushima University Graduate School, Tokushima, Japan
| | - Taiga Itagaki
- Emergency and Critical Care Medicine, Tokushima University Graduate School, Tokushima, Japan
| | - Masami Sato
- Department of Laboratory Medicine, Tokushima University Hospital, Tokushima, Japan
| | - Jun Oto
- Emergency and Disaster Medicine, Tokushima University Hospital, Tokushima, Japan
| | - Masaji Nishimura
- Emergency and Critical Care Medicine, Tokushima University Graduate School, Tokushima, Japan.
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16
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Bennett DJ, Itagaki T, Chenelle CT, Bittner EA, Kacmarek RM. Evaluation of the Augmented Infant Resuscitator: A Monitoring Device for Neonatal Bag-Valve-Mask Resuscitation. Anesth Analg 2018; 126:947-955. [PMID: 28863023 DOI: 10.1213/ane.0000000000002432] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Annually, 6 million newborns require bag-valve-mask resuscitation, and providing live feedback has the potential to improve the quality of resuscitation. The Augmented Infant Resuscitator (AIR), a real-time feedback device, has been designed to identify leaks, obstructions, and inappropriate breath rates during bag-valve-mask resuscitation. However, its function has not been evaluated. METHODS The resistance of the AIR was measured by attaching it between a ventilator and a ventilator tester. To test the device's reliability in training and clinical-use settings, it was placed in-line between a ventilation bag or ventilator and a neonatal manikin and a clinical lung model simulator. The lung model simulator simulated neonates of 3 sizes (2, 4, and 6 kg). Leaks, obstructions, and respiratory rate alterations were introduced. RESULTS At a flow of 5 L/min, the pressure drop across the AIR was only 0.38 cm H2O, and the device had almost no effect on ventilator breath parameters. During the manikin trials, it was able to detect all leaks and obstructions, correctly displaying an alarm 100% of the time. During the simulated clinical trials, the AIR performed best on the 6-kg neonatal model, followed by the 4-kg model, and finally the 2-kg model. Over all 3 clinical models, the prototype displayed the correct indicator 73.5% of the time, and when doing so, took 1.6 ± 0.9 seconds. CONCLUSIONS The AIR is a promising innovation that has the potential to improve neonatal resuscitation. It introduces only marginal resistance and performs well on neonatal manikins, but its firmware should be improved before clinical use.
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Affiliation(s)
- Desmond J Bennett
- From the Department of Respiratory Care, Massachusetts General Hospital, Boston, Massachusetts
| | - Taiga Itagaki
- From the Department of Respiratory Care, Massachusetts General Hospital, Boston, Massachusetts.,Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Christopher T Chenelle
- From the Department of Respiratory Care, Massachusetts General Hospital, Boston, Massachusetts
| | - Edward A Bittner
- Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Robert M Kacmarek
- From the Department of Respiratory Care, Massachusetts General Hospital, Boston, Massachusetts.,Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
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17
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Nakanishi N, Oto J, Itagaki T, Nakataki E, Onodera M, Nishimura M. Humidification Performance of Passive and Active Humidification Devices Within a Spontaneously Breathing Tracheostomized Cohort. Respir Care 2018; 64:130-135. [PMID: 30254040 DOI: 10.4187/respcare.06294] [Citation(s) in RCA: 2] [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] [Indexed: 11/05/2022]
Abstract
BACKGROUND Most heat-and-moisture exchangers (HMEs) for patients with tracheostomy and spontaneously breathing are small and have suction ports that allow some expiratory gas to escape, which loses water vapor held in the expired gas. Recently, a heated-and-humidified high-flow system for spontaneously breathing patients with tracheostomy was developed. Little is known, however, about the humidifying performance of HMEs or heated-and-humidified high-flow systems for spontaneous breathing patients with a tracheostomy. OBJECTIVE To investigate the humidifying performance of the HMEs and heated-and-humidified high-flow systems for spontaneously breathing patients with tracheostomy. METHODS Adult spontaneously breathing subjects with tracheostomy and were enrolled when their respiratory parameters and SpO2 were stable. We measured absolute humidity, relative humidity, and temperature by using a capacitance-type moisture sensor at the outlet of the tracheostomy tube. Heated-and-humidified high flow was delivered via the a humidifier and tracheostomy interface, and a selected HME. The subjects received heated-and-humidified high flow, after which an HME was used for humidification before switching back to a heated-and-humidified high-flow system. RESULTS Ten subjects (5 men, 5 women; mean ± SD age, 72 ± 12 y) were enrolled. The admission diagnoses were neurologic (5 subjects), respiratory failure (3), and cardiac arrest (2). The APACHE (Acute Physiology and Chronic Health Evaluation) II score was 24 (interquartile range, 20-27). Tracheostomy was performed on day 7 (interquartile range, 5-11 d) after endotracheal intubation, and the duration of mechanical ventilation was 10 d (interquartile range, 6-11 d). The temperature with the HME was 29.9 ± 1.0°C and, during heated-and-humidified high-flow use was 35.3 ± 0.8°C (P < .001). With both the HME and the heated-and-humidified high-flow system, the relative humidity reached 100%; the absolute humidity with HME was 30.2 ± 1.8 mg/L, and, with the heated-and-humidified high-flow system, was 40.3 ± 1.8 mg/L (P < .001). CONCLUSIONS In spontaneously breathing subjects with tracheostomy, an heated-and-humidified high-flow system achieved higher absolute humidity than did an HME.
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Affiliation(s)
- Nobuto Nakanishi
- Emergency and Critical Care Medicine, Tokushima University Hospital, Tokushima, Japan
| | - Jun Oto
- Emergency and Disaster Medicine, Tokushima University Hospital, Tokushima, Japan
| | - Taiga Itagaki
- Emergency and Critical Care Medicine, Tokushima University Hospital, Tokushima, Japan
| | - Emiko Nakataki
- Emergency and Critical Care Medicine, Tokushima University Hospital, Tokushima, Japan
| | - Mutsuo Onodera
- Emergency and Critical Care Medicine, Tokushima University Hospital, Tokushima, Japan
| | - Masaji Nishimura
- Emergency and Critical Care Medicine, Tokushima University Hospital, Tokushima, Japan.
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18
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Itagaki T, Nakanishi N, Okuda N, Nakataki E, Onodera M, Oto J, Nishimura M. Effect of High-Flow Nasal Cannula on Thoraco-Abdominal Synchrony in Pediatric Subjects After Cardiac Surgery. Respir Care 2018; 64:10-16. [PMID: 30206130 DOI: 10.4187/respcare.06193] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND We previously reported the effects of high-flow nasal cannula (HFNC) oxygen therapy on thoraco-abdominal synchrony. This study was designed to clarify the effect of HFNC on thoraco-abdominal synchrony in pediatric subjects after cardiac surgery and to investigate HFNC optimal flow in this population. METHODS Thoraco-abdominal synchrony was evaluated with respiratory inductive plethysmography. After extubation, we delivered oxygen via face mask for 30 min to subjects with mild to moderate respiratory failure. Each subject then randomly received either 1 or 2 L/kg/min via HFNC for 30 min, followed by the other flow level via HFNC for 30 min. After HFNC, face mask delivery was resumed. Rib cage and abdominal movement were converted into volumes and 2 quantitative indexes: maximum compartmental amplitude/tidal volume (VT) ratio and phase angle. RESULTS Ten subjects of median (interquartile range) age 7 (6-14) months and weighing 6.5 (5.3-8.8) kg were enrolled. Compared with the first delivery via face mask, breathing frequency, maximum compartmental amplitude/VT, phase angle, and minute volume significantly decreased at 2 L/kg/min (P < .05 for all) but not at 1 L/kg/min. PaCO2 did not differ among oxygen therapies. None of the measured variables differed between first and second face mask periods. CONCLUSIONS After cardiac surgery, HFNC oxygen therapy at 2 L/kg/min improved thoraco-abdominal synchrony and decreased breathing frequency in pediatric subjects. (Clinical trial registration: UMIN000023426.).
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Affiliation(s)
- Taiga Itagaki
- Emergency and Critical Care Medicine, Tokushima University Graduate School, 3-18-15 Kuramoto, Tokushima 770-8503, Japan
| | - Nobuto Nakanishi
- Emergency and Critical Care Medicine, Tokushima University Graduate School, 3-18-15 Kuramoto, Tokushima 770-8503, Japan
| | - Nao Okuda
- Emergency and Critical Care Medicine, Tokushima University Graduate School, 3-18-15 Kuramoto, Tokushima 770-8503, Japan
| | - Emiko Nakataki
- Emergency and Critical Care Medicine, Tokushima University Graduate School, 3-18-15 Kuramoto, Tokushima 770-8503, Japan
| | - Mutsuo Onodera
- Emergency and Critical Care Medicine, Tokushima University Graduate School, 3-18-15 Kuramoto, Tokushima 770-8503, Japan
| | - Jun Oto
- Department of Emergency and Disaster Medicine, Tokushima University Hospital, 2-50-1 Kuramoto, Tokushima 770-8503, Japan
| | - Masaji Nishimura
- Emergency and Critical Care Medicine, Tokushima University Graduate School, 3-18-15 Kuramoto, Tokushima 770-8503, Japan.
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Itagaki T, Ueno Y, Nakanishi N, Oto J. Reverse triggering induced by endotracheal tube leak in lightly sedated ARDS patient. J Intensive Care 2018; 6:41. [PMID: 30065843 PMCID: PMC6064044 DOI: 10.1186/s40560-018-0314-8] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2018] [Accepted: 07/19/2018] [Indexed: 11/24/2022] Open
Abstract
Reverse triggering is respiratory entrainment triggered by the ventilator especially seen among heavily sedated patients. We confirmed reverse triggering induced by auto-triggering in lightly sedated patient through an esophageal pressure monitoring. The reverse triggering frequently caused breath stacking with increased tidal volume. Physicians should be aware, even at an optimal level of sedation, that reverse triggering can develop, possibly caused by auto-triggering.
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Affiliation(s)
- Taiga Itagaki
- Department of Emergency and Critical Care Medicine, Tokushima University Graduate School, 3-18-15 Kuramoto-cho, Tokushima, 770-8503 Japan
| | - Yoshitoyo Ueno
- Department of Emergency and Critical Care Medicine, Tokushima University Graduate School, 3-18-15 Kuramoto-cho, Tokushima, 770-8503 Japan
| | - Nobuto Nakanishi
- Department of Emergency and Disaster Medicine, Tokushima University Hospital, 2-50-1 Kuramoto-cho, Tokushima, 770-8503 Japan
| | - Jun Oto
- Department of Emergency and Critical Care Medicine, Tokushima University Graduate School, 3-18-15 Kuramoto-cho, Tokushima, 770-8503 Japan
- Department of Emergency and Disaster Medicine, Tokushima University Hospital, 2-50-1 Kuramoto-cho, Tokushima, 770-8503 Japan
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20
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Affiliation(s)
- Taiga Itagaki
- Emergency and Critical Care Medicine Tokushima University Tokushima, Japan
| | - Masaji Nishimura
- Emergency and Critical Care Medicine Tokushima University Tokushima, Japan
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21
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Sato Y, Ohari Y, Itagaki T. Gastrointestinal pseudoparasitism by chestnut weevil ( Curculio sikkimensis
) larvae in a dog. J Small Anim Pract 2017; 58:302. [DOI: 10.1111/jsap.12627] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2016] [Accepted: 10/05/2016] [Indexed: 11/29/2022]
Affiliation(s)
- Y. Sato
- SATO Animal Clinic; Chikuma-Shi Nagano 387-0013 Japan
| | - Y. Ohari
- Laboratory of Veterinary Parasitology, Faculty of Agriculture; Iwate University; Morioka-Shi Iwate 020-8550 Japan
| | - T. Itagaki
- Laboratory of Veterinary Parasitology, Faculty of Agriculture; Iwate University; Morioka-Shi Iwate 020-8550 Japan
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22
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Itagaki T, Bennett DJ, Chenelle CT, Fisher DF, Kacmarek RM. Performance of Leak Compensation in All-Age ICU Ventilators During Volume-Targeted Neonatal Ventilation: A Lung Model Study. Respir Care 2016; 62:10-21. [PMID: 27879380 DOI: 10.4187/respcare.05012] [Citation(s) in RCA: 6] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Volume-targeted ventilation is increasingly used in low birthweight infants because of the potential for reducing volutrauma and avoiding hypocapnea. However, it is not known what level of air leak is acceptable during neonatal volume-targeted ventilation when leak compensation is activated concurrently. METHODS Four ICU ventilators (Servo-i, PB980, V500, and Avea) were compared in available invasive volume-targeted ventilation modes (pressure control continuous spontaneous ventilation [PC-CSV] and pressure control continuous mandatory ventilation [PC-CMV]). The Servo-i and PB980 were tested with (+) and without (-) their proximal flow sensor. The V500 and Avea were tested with their proximal flow sensor as indicated by their manufacturers. An ASL 5000 lung model was used to simulate 4 neonatal scenarios (body weight 0.5, 1, 2, and 4 kg). The ASL 5000 was ventilated via an endotracheal tube with 3 different leaks. Two minutes of data were collected after each change in leak level, and the asynchrony index was calculated. Tidal volume (VT) before and after the change in leak was assessed. RESULTS The differences in delivered VT between before and after the change in leak were within ±5% in all scenarios with the PB980 (-/+) and V500. With the Servo-i (-/+), baseline VT was ≥10% greater than set VT during PC-CSV, and delivered VT markedly changed with leak. The Avea demonstrated persistent high VT in all leak scenarios. Across all ventilators, the median asynchrony index was 1% (interquartile range 0-27%) in PC-CSV and 1.8% (0-45%) in PC-CMV. The median asynchrony index was significantly higher in the Servo-i (-/+) than in the PB980 (-/+) and V500 in 1 and 2 kg scenarios during PC-CSV and PC-CMV. CONCLUSIONS The PB980 and V500 were the only ventilators to acclimate to all leak scenarios and achieve targeted VT. Further clinical investigation is needed to validate the use of leak compensation during neonatal volume-targeted ventilation.
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Affiliation(s)
- Taiga Itagaki
- Department of Respiratory Care.,Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | | | | | | | - Robert M Kacmarek
- Department of Respiratory Care .,Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
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Chenelle CT, Itagaki T, Fisher DF, Berra L, Kacmarek RM. Performance of the PneuX System: A Bench Study Comparison With 4 Other Endotracheal Tube Cuffs. Respir Care 2016; 62:102-112. [PMID: 27879379 DOI: 10.4187/respcare.04996] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Cuff design affects microaspiration, a risk factor for pneumonia. We questioned whether the PneuX low-volume fold-free cuff design would prevent cuff leakage and maintain the same tracheal wall pressure as high-volume, low-pressure (HVLP) cuffs. METHODS We evaluated 4 HVLP-cuffed endotracheal tubes (ETTs), Hi-Lo (polyvinyl chloride [PVC]), Microcuff (polyurethane [PU]), SealGuard (PU + tapered), and TaperGuard (PVC + tapered), and the PneuX with its dedicated tracheal seal monitor. In Part 1, we determined tracheal wall pressure using each cuff's capacity to support water columns across recommended intracuff pressures. In Part 2, we evaluated the tracheal seal monitor function at recommended settings. In Part 3, we compared leakage volumes of all ETTs during 30 min of simulated mechanical ventilation or during 8 h if no leak occurred. Parts 1 and 3 were performed with/without lubrication and PEEP. RESULTS In Part 1, PneuX cuffs exerted an average tracheal wall pressure of 27.4 ± 2.4 cm H2O at the recommended intracuff pressure of approximately 80 cm H2O. Tracheal wall pressure did not differ among HVLP cuffs (19.6 ± 1.4 to 29.5 ± 1.4 cm H2O). In Part 2, preinflation intracuff pressure affected the time to obtain tracheal seal monitor pressure attainment (P < .01). The tracheal seal monitor generated average calculated tracheal wall pressure of 33.4 ± 1.2 cm H2O. In Part 3, PneuX ETT showed no leak across 8 h for all trials. Overall, leakage volume was lower with PU (P < .01) and PneuX (P < .01) than with PVC cuffs, regardless of shape, and lower with lubrication and/or PEEP (all P < .01). In each HVLP cuff, lubrication alone eliminated leak at an intracuff pressure of ≤30 cm H2O. CONCLUSIONS The PneuX cuff generally exerted acceptable tracheal wall pressure, but the tracheal wall pressure monitor allowed pressures exceeding 30 cm H2O in some trials and was the only ETT to prevent leak in all tests. For HVLP cuffs, leak was reduced by PU and PEEP and eliminated by lubrication.
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Affiliation(s)
| | - Taiga Itagaki
- Department of Anesthesia, Critical Care, and Pain Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
| | - Daniel F Fisher
- Department of Respiratory Care, Massachusetts General Hospital, Boston, Massachusetts
| | - Lorenzo Berra
- Department of Anesthesia, Critical Care, and Pain Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
| | - Robert M Kacmarek
- Department of Respiratory Care, Massachusetts General Hospital, Boston, Massachusetts. .,Department of Anesthesia, Critical Care, and Pain Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
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Itagaki T, Chenelle CT, Bennett DJ, Fisher DF, Kacmarek RM. Effects of Leak Compensation on Patient-Ventilator Synchrony During Premature/Neonatal Invasive and Noninvasive Ventilation: A Lung Model Study. Respir Care 2016; 62:22-33. [PMID: 27651525 DOI: 10.4187/respcare.04825] [Citation(s) in RCA: 8] [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] [Indexed: 11/05/2022]
Abstract
BACKGROUND During both nasal noninvasive ventilation (NIV) and invasive ventilation of neonates, the presence of air leaks causes triggering and cycling asynchrony. METHODS Five ICU ventilators (PB840, PB980, Servo-i, V500, and Avea) were compared in available invasive ventilation and NIV ventilator modes (pressure control continuous spontaneous ventilation [PC-CSV] and pressure control continuous mandatory ventilation [PC-CMV]). The V500 and Avea do not provide PC-CSV and PC-CMV in NIV. The Servo-i and Avea were tested with and without their proximal flow sensor. The ASL 5000 lung model (version 3.5) was used to simulate 4 neonatal scenarios (body weight 0.5, 1, 2, and 4 kg). The ASL 5000 was ventilated via endotracheal tube (invasive ventilation) or nasal cannula (NIV) with 4 different leaks. RESULTS The Avea (without flow sensor) during invasive ventilation and Servo-i and PB840 during NIV were not triggered by inspiratory efforts of the ASL 5000 at the baseline leak in the 0.5 kg scenario. In invasive ventilation, overall (median) asynchrony index was significantly lower with the PB980 (1%) and V500 (3%) than with the Servo-i (with flow sensor, 50%; without flow sensor, 50%) and Avea (with sensor, 50%; without sensor, 62%) (P < .05 for all comparisons). The PB840 (33%) was significantly different from all ventilators (P < .05). In NIV, the asynchrony index was significantly lower in PB980 (2%) than in the Servo-i (with sensor, 100%; without sensor, 100%) and PB840 (75%) (P < .05 for both). There was no difference in asynchrony index between PC-CSV and PC-CMV in all tested conditions and ventilators. CONCLUSIONS The ability of leak compensation to prevent asynchronous breathing varied widely between ventilators and lung mechanics. The PB980 and V500 were the only two ventilators to acclimate to all leak scenarios in invasive ventilation, and PB980 was the only ventilator to acclimate to all leak scenarios in NIV.
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Affiliation(s)
- Taiga Itagaki
- Department of Respiratory Care, Massachusetts General Hospital, Boston, Massachusetts.,Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | | | - Desmond J Bennett
- Department of Respiratory Care, Massachusetts General Hospital, Boston, Massachusetts
| | - Daniel F Fisher
- Department of Respiratory Care, Massachusetts General Hospital, Boston, Massachusetts
| | - Robert M Kacmarek
- Department of Respiratory Care, Massachusetts General Hospital, Boston, Massachusetts. .,Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
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Itagaki T, Gubin TA, Sayal P, Jiang Y, Kacmarek RM, Anderson TA. The effectiveness of nasal mask vs face mask ventilation in anesthetized, apneic pediatric subjects over 2 years of age: a randomized controlled trial. Paediatr Anaesth 2016; 26:173-81. [PMID: 26725988 DOI: 10.1111/pan.12822] [Citation(s) in RCA: 2] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/01/2015] [Indexed: 11/28/2022]
Abstract
BACKGROUND We hypothesized that anesthetized, apneic children could be ventilated equivalently or more efficiently by nasal mask ventilation (NMV) than face mask ventilation (FMV). The aim of this randomized controlled study was to test this hypothesis by comparing the expiratory tidal volume (Vte) between NMV and FMV. METHODS After the induction of anesthesia, 41 subjects, 3-17 years of age without anticipated difficult mask ventilation, were randomly assigned to receive either NMV or FMV with neck extension. Both groups were ventilated with pressure control ventilation (PCV) at 20 cmH2 O of peak inspiratory pressure (PIP) with positive end-expiratory pressure (PEEP) levels of 0, 5, and 10 cmH2 O. An additional mouth closing maneuver (MCM) was applied for the NMV group. RESULTS The Vte was higher in the FMV group compared with the NMV group (median difference [95% CI]: 8.4 [5.5-11.6] ml·kg(-1) ; P < 0.001) when MCM was not applied. NMV achieved less PEEP than FMV (median difference [95% CI]: 5.0 [4.3-5.3] cmH2 O at 10 cmH2 O; P < 0.001) though both groups achieved the set PIP level. In the NMV group, MCM markedly increased Vte (median increase [95% CI]: 5.9 [2.5-9.0] ml·kg(-1) ; P < 0.005) and PEEP (median increase [95% CI]: 5.0 [0.6-8.6] cmH2 O at 10 cmH2 O; P < 0.005); however, PEEP was highly variable and lower than that of FMV (median difference [95% CI]: 2.5 [0.8-8.5] cmH2 O at 10 cmH2 O; P < 0.05). CONCLUSIONS In anesthetized, apneic children greater than 2 years of age ventilated with an anesthesia ventilator and neck extension, FMV established a greater Vte than NMV regardless of mouth status. NMV could not maintain the set PEEP level due to an air leak from the mouth. The MCM increased the Vte and PEEP.
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Affiliation(s)
- Taiga Itagaki
- Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.,Respiratory Care Services, Massachusetts General Hospital, Boston, MA, USA
| | - Tatyana A Gubin
- Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.,Department of Mechanical Engineering, Massachusetts Institute of Technology, Cambridge, MA, USA
| | - Puneet Sayal
- Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Yandong Jiang
- Department of Anesthesia, Vanderbilt Medical Center, Nashville, TN, USA
| | - Robert M Kacmarek
- Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.,Respiratory Care Services, Massachusetts General Hospital, Boston, MA, USA
| | - Thomas Anthony Anderson
- Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
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Chikata Y, Izawa M, Okuda N, Itagaki T, Nakataki E, Onodera M, Imanaka H, Nishimura M. Humidification performance of two high-flow nasal cannula devices: a bench study. Respir Care 2015; 59:1186-90. [PMID: 24368861 DOI: 10.4187/respcare.02932] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
INTRODUCTION Delivering heated and humidified medical gas at 20-60 L/min, high-flow nasal cannula (HFNC) creates low levels of PEEP and ameliorates respiratory mechanics. It has become a common therapy for patients with respiratory failure. However, independent measurement of heat and humidity during HFNC and comparison of HFNC devices are lacking. METHODS We evaluated 2 HFNC (Airvo 2 and Optiflow system) devices. Each HFNC was connected to simulated external nares using the manufacturer's standard circuit. The Airvo 2 outlet-chamber temperature was set at 37°C. The Optiflow system incorporated an O2/air blender and a heated humidifier, which was set at 40°C/3. For both systems, HFNC flow was tested at 20, 40, and 50 L/min. Simulating spontaneous breathing using a mechanical ventilator and TTL test lung, we tested tidal volumes (VT) of 300, 500, and 700 mL, and breathing frequencies of 10 and 20 breaths/min. The TTL was connected to the simulated external nares with a standard ventilator circuit. To prevent condensation, the circuit was placed in an incubator maintained at 37°C. Small, medium, and large nasal prongs were tested. Absolute humidity (AH) of inspired gas was measured at the simulated external nares. RESULTS At 20, 40, and 50 L/min of flow, respective AH values for the Airvo 2 were 35.3 ± 2.0, 37.1 ± 2.2, and 37.6 ± 2.1 mg/L, and for the Optiflow system, 33.1 ± 1.5, 35.9 ± 1.7, and 36.2 ± 1.8 mg/L. AH was lower at 20 L/min of HFNC flow than at 40 and 50 L/min (P < .01). While AH remained constant at 40 and 50 L/min, at 20 L/min of HFNC flow, AH decreased as VT increased for both devices. CONCLUSIONS During bench use of HFNC, AH increased with increasing HFNC flow. When the inspiratory flow of spontaneous breathing exceeded the HFNC flow, AH was influenced by VT. At all experimental settings, AH remained > 30 mg/L.
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Onodera M, Okuda N, Izawa M, Itagaki T, Nishimura M. Sedative use and delirium during noninvasive positive pressure ventilation: A prospective observational study. J Crit Care 2015. [DOI: 10.1016/j.jcrc.2015.04.071] [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: 10/23/2022]
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Kikura M, Suzuki Y, Itagaki T, Sato T, Nishino J. [Vocal cord paralysis associated with tracheal intubation: incidence, risk analysis, and classification of severity]. Masui 2015; 64:57-59. [PMID: 25993750] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Vocal cord paralysis after tracheal intubation is rare. It causes severe hoarseness and aspiration, and delays recovery and discharge. Arytenoid cartilage dislocation and recurrent nerve paralysis are main causes of vocal cord paralysis. Physical stimulation of the tracheal tube as well as patient and surgical characteristics also contribute. Vocal cord paralysis occurs in 1 (0.07%) of 1,500 general surgery patients and on the left side in 70% of cases. It is associated with surgery/anesthesia time (two-fold, 3-6 hours; 15-fold, over 6 hours), age (three-fold, over 50 years), and diabetes mellitus or hypertension (two-fold). Symptoms resolve in 2-3 months. In adult cardiovascular surgery, vocal cord paralysis occurs in 1 (0.7-2%) of 50-100 cardiac surgery patients and 1 (8.6-32%) of 3-10 thoracic aortic surgery patients. In pediatric cardiac surgery, vocal cord paralysis occurs in 1 (0.1-0.5%) of 200-1,000 patients. We classified the severity of vocal cord paralysis as I, severe hoarseness; II, aspiration or dysphagia; and III, bilateral vocal cord paralysis, aspiration pneumonia, or the need for tracheal re-intubation or tracheotomy. We discuss the importance of informed consent for the patient and family.
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Itagaki T, Nakano Y, Okuda N, Izawa M, Onodera M, Imanaka H, Nishimura M. Hyperoxemia in mechanically ventilated, critically ill subjects: incidence and related factors. Respir Care 2014; 60:335-40. [PMID: 25389354 DOI: 10.4187/respcare.03451] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Excessive supplemental oxygen causes injurious hyperoxemia. Before establishing the best P(aO2) targets for mechanically ventilated patients, it is important to understand the incidence of hyperoxemia and related factors. We investigated oxygenation in mechanically ventilated subjects in our ICU and evaluated factors related to hyperoxemia (P(aO2) > 120 mm Hg) at 48 h after initiation of mechanical ventilation. METHODS We retrospectively reviewed the medical records of patients admitted to our ICU from January 2010 to May 2013. Inclusion criteria were 15 y of age or older and administration of mechanical ventilation for > 48 h. Patients at risk of imminent death on admission or who had received noninvasive ventilation were excluded. We collected subject demographics, reasons for mechanical ventilation, and during mechanical ventilation, we collected arterial blood gas data and ventilator settings on the first day of intubation (T1), 48 h after initiation of mechanical ventilation (T2), and on the day of extubation (T3). Multivariable logistic regression analysis was performed to clarify independent variables related to hyperoxemia at T2. RESULTS For the study period, data for 328 subjects were analyzed. P(aO2) statistically significantly increased over time to 90 (interquartile range of 74-109) mm Hg at T1, 105 (89-120) mm Hg at T2, and 103 (91-119) mm Hg at T3 (P < .001), coincident with decreases in F(IO2) of 0.4 (0.3-0.5) at T1, 0.3 (0.3-0.4) at T2, and 0.3 (0.3-0.35) at T3 (P < .001). Hyperoxemia occurred in 15.6% (T1), 25.3% (T2), and 22.4% (T3) of subjects. Multivariable logistic regression analysis revealed that hyperoxemia was independently associated with age of < 40 y (odds ratio 2.6, 95% CI 1.1-6.0), Acute Physiology and Chronic Health Evaluation II scores of ≥ 30 (odds ratio 0.53, 95% CI 0.3-1.0), and decompensated heart failure (odds ratio 1.9, 95% CI 1.1 to 3.5). CONCLUSIONS During mechanical ventilation of critically ill subjects, P(aO2) increased, and F(IO2) decreased. One in 4 subjects were hyperoxemic at T2, and hyperoxemia persisted until T3.
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Affiliation(s)
- Taiga Itagaki
- Department of Emergency and Critical Care Medicine, University of Tokushima Graduate School, Tokushima, Japan
| | - Yuuki Nakano
- University of Tokushima Medical School, Tokushima, Japan
| | - Nao Okuda
- Department of Emergency and Critical Care Medicine, University of Tokushima Graduate School, Tokushima, Japan
| | - Masayo Izawa
- Department of Emergency and Critical Care Medicine, University of Tokushima Graduate School, Tokushima, Japan
| | - Mutsuo Onodera
- Department of Emergency and Critical Care Medicine, University of Tokushima Graduate School, Tokushima, Japan
| | - Hideaki Imanaka
- Department of Emergency and Disaster Medicine, Tokushima University Hospital, Tokushima, Japan
| | - Masaji Nishimura
- Department of Emergency and Critical Care Medicine, University of Tokushima Graduate School, Tokushima, Japan.
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Okuda N, Tsunano Y, Kohata H, Nakataki E, Itagaki T, Onodera M, Imanaka H, Nishimura M. [Delayed discharge from the intensive care unit]. Masui 2014; 63:1164-1166. [PMID: 25693354] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
BACKGROUND Delayed discharge from ICU to the general ward can exert an adverse effect. We researched whether patients are discharged smoothly from our ICU to the general ward. METHODS We defined that patients were eligible for discharge if they are without administration of catecholamine, being assisted by mechanical ventilation and having blood purification therapy. RESULTS Average time from actual discharge to the time patient was considered eligible for discharge was fifteen hours. This study was retrospective. CONCLUSIONS We need to investigate further the reasons why delayed discharge occurred. It is im portant that patients are discharged from the ICU to the general ward properly. Delayed discharge can delay the recovery and expose the patient to multi-resistant microorganisms. We studied whether patients are discharged smoothly from the ICU to the general ward.
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Okuda N, Nakataki E, Itagaki T, Onodera M, Imanaka H, Nishimura M. Complete bronchial obstruction by granuloma in a paediatric patient with translaryngeal endotracheal tube: a case report. J Med Case Rep 2014; 8:260. [PMID: 25060137 PMCID: PMC4112840 DOI: 10.1186/1752-1947-8-260] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2014] [Accepted: 06/02/2014] [Indexed: 11/25/2022] Open
Abstract
Introduction Although continuous or frequent stimuli in tracheostomized patients may cause tracheal granulomas, little is known about management of patients with translaryngeal intubation. Case presentation A 1-month-old Japanese boy, weighing 3.5kg, was admitted to our hospital owing to cardiac failure caused by an atrial septal defect and intractable arrhythmia. To treat his unstable cardiovascular status, surgery was performed to close his atrial septal defect. After the operation, stenosis was detected by auscultation and flow limitation worsened. A bronchoscopy revealed granulomas completely obstructing his right bronchus and partially obstructing his left bronchus. Dexamethasone infusion partially reduced the mass, after which removal by yttrium aluminium garnet laser was tried. The airway obstruction was not resolved, however, because of granuloma reproliferation. Budesonide (aerosol liquid) inhalation was started, and tissue was reduced using an yttrium aluminium garnet laser and physically removed using forceps. After continued budesonide inhalation, he was successfully liberated from the ventilator. Conclusions Life-threatening airway obstruction by granulomas developed in a translaryngeally intubated paediatric patient. The granuloma was detected after a couple of weeks of intubation. A bronchial granuloma is rare in paediatric patients. It should be suspected with evidence of bronchial obstruction. Treatment with corticosteroids and surgery using a laser maybe indicated.
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Itagaki T, Onodera M, Okuda N, Nakataki E, Imanaka H, Nishimura M. Successful use of extracorporeal membrane oxygenation in the reversal of cardiorespiratory failure induced by atonic uterine bleeding: a case report. J Med Case Rep 2014; 8:23. [PMID: 24468287 PMCID: PMC3917368 DOI: 10.1186/1752-1947-8-23] [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: 08/09/2013] [Accepted: 11/19/2013] [Indexed: 11/23/2022] Open
Abstract
Introduction Although extracorporeal membrane oxygenation has made sufficient progress to be considered for the management of life-threatening cardiac and respiratory failure, the risk of hemorrhagic complications may outweigh the benefits for patients with bleeding tendencies. We report, to the best of our knowledge, the first case of successful treatment by extracorporeal membrane oxygenation, without any hemorrhagic complications, of postpartum cardiorespiratory failure after massive uterine bleeding. Case presentation A 25-year-old Japanese woman experienced massive atonic bleeding after delivering her second baby. Recovery from hemorrhagic shock was managed by conservative treatments, but she developed decompensated heart failure and refractory hypoxia. Because we could not obtain hemodynamic stability and proper oxygenation even with high doses of catecholamines and maximal ventilator settings, we administered venoarterial extracorporeal membrane oxygenation, whereupon her hemodynamic status immediately stabilized. After 72 hours of support without major bleeding, extracorporeal membrane oxygenation was successfully withdrawn. Conclusion Even in cases of obstetric bleeding, if clotting status is stringently monitored, extracorporeal membrane oxygenation can be considered as an ultimate means of life support.
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Affiliation(s)
| | | | | | | | | | - Masaji Nishimura
- Department of Emergency and Critical Care Medicine, Tokushima University Hospital, 3-18-15 Kuramoto-cho, Tokushima 7708503, Japan.
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Kohata H, Okuda N, Nakataki E, Itagaki T, Onodera M, Imanaka H, Nishimura M. A novel method of post-pyloric feeding tube placement at bedside. J Crit Care 2013; 28:1039-41. [PMID: 24018178 DOI: 10.1016/j.jcrc.2013.06.018] [Citation(s) in RCA: 11] [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: 04/16/2013] [Revised: 06/06/2013] [Accepted: 06/30/2013] [Indexed: 01/15/2023]
Abstract
PURPOSE Post-pyloric feeding tube placement is often difficult, and special equipment or peristalsis agents are used to aid insertion. Although several reports have described blind techniques for post-pyloric feeding-tube placement, no general consensus about method preference has been achieved. MATERIALS AND METHODS The technique is performed as follows: via the nostril, a stylet-tipped feeding tube is advanced about 70 cm; to confirm tip location to the right of the epigastric area, towards the right hypochondriac region, 5 mL shots of air are injected to enable touch detection of bubbling; finally, the tube is advanced to a length of 100 cm, during which the strength of bubbling seems to diminish under palpation. RESULTS We prospectively enrolled consecutive patients whose oral intake was expected to be difficult for 48 hours in the intensive care unit. Forty-one patients were enrolled and the rate of successful placement at first attempt was 95.1%. Mean duration for successful placement was 15 minutes. CONCLUSIONS With a novel technique, from the bedside, without special tools or drugs, we successfully placed post-pyloric feeding tubes. Essential points when inserting the tube are confirmation of the location of the tube tip by palpation of injected air, and to avoid deflection and looping.
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Affiliation(s)
- Hisakazu Kohata
- Emergency and Critical Care Medicine, The University of Tokushima Graduate School, 3-18-15 Kuramoto, Tokushima 770-8503, Japan
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Itagaki T, Okuda N, Tsunano Y, Kohata H, Nakataki E, Onodera M, Imanaka H, Nishimura M. Effect of high-flow nasal cannula on thoraco-abdominal synchrony in adult critically ill patients. Respir Care 2013; 59:70-4. [PMID: 23737548 DOI: 10.4187/respcare.02480] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND High-flow nasal cannula (HFNC) creates positive oropharyngeal airway pressure and improves oxygenation. It remains unclear, however, whether HFNC improves thoraco-abdominal synchrony in patients with mild to moderate respiratory failure. Using respiratory inductive plethysmography, we investigated the effects of HFNC on thoraco-abdominal synchrony. METHODS We studied 40 adult subjects requiring oxygen therapy in the ICU. Low-flow oxygen (up to 8 L/min) was administered via oronasal mask for 30 min, followed by HFNC at 30-50 L/min. Respiratory inductive plethysmography transducer bands were circumferentially placed: one around the rib cage, and one around the abdomen. We measured the movement of the rib-cage and abdomen, and used the sum signal to represent tidal volume (V(T)) during mask breathing, and at 30 min during HFNC. We calculated the ratio of maximum compartmental amplitude (MCA) to V(T), and the phase angle. We assessed arterial blood gas and vital signs at each period, and mouth status during HFNC. We used multiple regression analysis to identify factors associated with improvement in thoraco-abdominal synchrony. RESULTS During HFNC, breathing frequency significantly decreased from 25 breaths/min (IQR 22-27 breaths/min) to 21 breaths/min (IQR 18-24 breaths/min) (P < .001), and MCA/VT (P < .001) and phase angle (P = .047) significantly improved. CONCLUSIONS HFNC improved thoraco-abdominal synchrony in adult subjects with mild to moderate respiratory failure.
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Affiliation(s)
- Taiga Itagaki
- Department of Emergency and Critical Care Medicine, University of Tokushima Graduate School
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Itagaki T, Suzuki Y, Seto J, Abiko C, Mizuta K, Matsuzaki Y. Two cases of macrolide resistance in Mycoplasma pneumoniae acquired during the treatment period. J Antimicrob Chemother 2012; 68:724-5. [DOI: 10.1093/jac/dks454] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Abstract
Fasciola spp. were collected from naturally infected cattle at a local abattoir of Khanh Hoa province, Vietnam, for morphological and genetic investigations. Microscopic examination detected no sperm cells in the seminal vesicles, suggesting a parthenogenetic reproduction of the flukes. Analyses of sequences from the first and second internal transcribed spacers (ITS1 and ITS2) of the ribosomal RNA revealed that 13 out of 16 isolates were of Fasciola gigantica type, whereas three isolates presented a hybrid sequence from F. gigantica and Fasciola hepatica. Interestingly, all the mitochondrial sequences (partial COI and NDI) were of F. gigantica type, suggesting that the maternal lineage of the hybrid form is from F. gigantica. No intra-sequence variation was detected.
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Affiliation(s)
- S Nguyen
- Laboratory of Sustainable Environmental Biology, Field Centre studies, Graduate School of Agricultural Science, Tohoku University, 232-3 Yomogida, Naruko-onsen, Osaki, Miyagi 989-6711, Japan
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Itoh N, Itagaki T, Kawabata T, Konaka T, Muraoka N, Saeki H, Kanai K, Chikazawa S, Hori Y, Hoshi F, Higuchi S. Prevalence of intestinal parasites and genotyping of Giardia intestinalis in pet shop puppies in east Japan. Vet Parasitol 2010; 176:74-8. [PMID: 21093154 DOI: 10.1016/j.vetpar.2010.10.048] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2010] [Revised: 10/20/2010] [Accepted: 10/20/2010] [Indexed: 11/25/2022]
Abstract
The current study examined the prevalence of intestinal parasites and genotypes of Giardia intestinalis in puppies from nine pet shops in east Japan. Fresh fecal samples from 1794 puppies (≦3 months old) were collected on one occasion. Giardia spp. was examined for specific coproantigen using ELISA kit (SNAP®Giardia, IDEXX Laboratories, Inc., USA). Other intestinal parasites were detected microscopically using the formalin-ethyl acetate sedimentation technique. Genotyping was determined for the random 29 stool samples identified as Giardia spp. positive using PCR and direct sequencing of the glutamate dehydrogenase (gdh) gene. Overall prevalence of protozoan Giardia spp. and Cystoisospora spp. revealed 23.4% and 11.3%, respectively. Prevalence of ascarids, Strongyloides spp. and hookworms were recorded 1.8%, 1.1% and 0.1%, respectively. Protozoan Giardia spp. and Cystoisospora spp., thus, represent important pathogens among pet shop puppies. All genotyped G. intestinalis isolates were belonged to assemblage C or D, identified as dog-specific genotypes. Zoonotic assemblage A and B were not demonstrated. The result suggests that the risk of zoonotic transmission of G. intestinalis from pet shops puppies to humans may be quite low in Japan.
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Affiliation(s)
- N Itoh
- First Department of Small Animal Internal Medicine, School of Veterinary Medicine, Kitasato University, Towada, Aomori 034-8628, Japan.
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Kawashima S, Itagaki T, Adachi Y, Ishii Y, Taniguchi M, Doi M, Sato S. [Inadvertent thoracic duct puncture during right axially central venous cannulation]. Masui 2010; 59:1298-1300. [PMID: 20960908] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
A case of inadvertent thoracic duct puncture during right axially central venous cannulation is reported. The catheterization was performed under the real time ultrasound guidance technique and the coronal view image was continuously displayed. After confirming the feelings of venous puncture, clear yellow fluid was aspired into the connected syringe to the needle. Initially, an accidental thoracic puncture with subsequent pleural fluid aspiration was suspected;however, no finding of pleural effusion was observed with ultrasound imaging and computed tomography. Thus, an accidental thoracic duct puncture and the subsequent lymph fluid aspiration were suspected. Even in a right side approach for central venous catheterization, thoracic duct injury might ensure.
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Affiliation(s)
- Shingo Kawashima
- Department of Anesthesia and Resuscitation, University Hospital, Hamamatsu University School of Medicine, Hamamatsu 431-3192
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Katoh H, Itagaki T, Suzuki K, Obata Y, Adachi Y, Doi M, Sato S. [Successful extubation in a patient with alacepril-induced tongue angioedema]. Masui 2010; 59:519-522. [PMID: 20420150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
We describe a case of marked swelling of the tongue in a patient after a long prone position neurosurgery, who was treated for hypertension with alacepril. The tongue was not congestive and history of taking an angiotensin-converting enzyme inhibitor suggested an alacepril-induced angioedema. The day after surgery, the patient's tongue was still swollen; however, fibrescopic observation of the larynx and pharynx through the nasal cavity revealed that the edema was limited to anterior tongue, and the oral cavity and oropharynx were not involved. Although, tongue angioedema was observed, we introduced a 3-mm tube exchanger to the patient's trachea and removed the endotracheal tube. The ventilation and oxygenation were maintained, and 30 min later, the exchanger was detached. On the second postoperative day, the angioedema disappeared completely and the patient was transferred to a ward without any complication.
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Affiliation(s)
- Hiromi Katoh
- Intensive Care Unit of University Hospital, Hamamatsu University School of Medicine, Hamamatsu 431-3192
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Ohshima M, Hori E, Suzuki A, Katoh H, Itagaki T, Adachi Y, Doi M, Sato S. [Nasogastric tube syndrome suspected at the end of anesthesia]. Masui 2010; 59:495-497. [PMID: 20420143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
The case of a patient who might have developed nasogastric tube syndrome at the end of anesthesia is presented. A 62-year-old woman was scheduled for a general anesthesia with fiberscopic oro-tracheal intubation because of a predicted difficult airway. After the smooth and gentle intubation without any trauma and injury, a nasogastric tube was inserted blindly. At the end of surgery, the anesthesiologists observed the pharyngeal tissue and found significant edema on the epiglottis and arytenoids. Extubation was cancelled and the patient was moved to an intensive care unit for respiratory management. On the next day, fiberscopic observation revealed a complete recovery and the endotracheal tube was removed without any difficulty. We strongly suspected the pharyngeal injury as acute nasogastric tube syndrome and an attention to this rare complication is required by anesthesiologists.
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Affiliation(s)
- Misako Ohshima
- Department of Anesthesia and Resuscitation, University Hospital, Hamamatsu University School of Medicine, Hamamatsu 431-3192
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Itagaki T, Uchisaki S, Adachi Y, Suzuki K, Obata Y, Doi M, Sato S. [Apnea and severe respiratory depression induced by dexmedetomidine after general anesthesia in intensive care unit]. Masui 2009; 58:1534-1537. [PMID: 20055202] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
Dexmedetomidine (DEX) is widely used in intensive care unit for perioperative sedation. The one advantage of DEX administration for sedation is the lack of significant respiratory depression. However, DEX shows significant interaction with anesthetics and narcotics, and we present a case in which post-anesthetic administration of DEX induced apnea and severe respiratory depression after extubation. A 74-year-old, 38.3 kg, 148 cm woman was scheduled to undergo implantation of internal cardiac defibrillator. General anesthesia was maintained by sevoflurane, remifentanil and intermittent administration of fentanyl. After the surgery, she was transferred to intensive care unit with intubation, and DEX administration was commenced. After 3.5 hr from the end of anesthesia, the patient's trachea was extubated under continuous infusion of DEX (0.26 microg x kg(-1) x hr(-1)). Ninety min later, she showed apnea and severe respiratory depression. The interaction of DEX and residual narcotics might have induced life-threatening respiratory complication.
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Affiliation(s)
- Taiga Itagaki
- Intensive Care Unit of University Hospital, Hamamatsu University School of Medicine, Hamamatsu 431-3192
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Adachi Y, Uchisaki S, Itagaki T, Suzuki K, Obata Y, Doi M, Sato S. [Serotonin syndrome caused by an overdose of dextromethorphan, Medicon]. Masui 2009; 58:1531-1533. [PMID: 20055201] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
We report the first case of serotonin syndrome caused by overdose of dextromethorphan in Japan. A 34-year-old woman with schizophrenia received a dextromethorphan (Medicon) for a catarrhal symptom from two individual departments of the university hospital by chance. The daily amount of dextromethorphan was up to 180 mg for several days in addition to other regular antipsychotic drugs including risperidone, amitriptyline and levomepromazine. Finally, she was found in deep comatose state (GCS coma scale: E1V1M1) and the trachea was intubated in the emergency room. After admission to intensive care unit, the consciousness gradually improved; however, she was confused and agitated. The situation was normalized within next 24 hours and she was weaned from the mechanical ventilation next day. Serotonin syndrome demonstrates various signs and might be overlooked in an emergency room. Dextromethorphan is considered as a safe antitussive drug; however, the unexpected interaction should be suspected during chronic medical treatment.
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Affiliation(s)
- Yushi Adachi
- Intensive Care Unit of University Hospital, Hamamatsu University School of Medicine, Hamamatsu 431-3192
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Adachi YU, Obata Y, Suzuki K, Katoh H, Itagaki T, Doi M, Sato S. Nafamostat prevents hypothermia and improves survival time after administration of lipopolysaccharide in a mouse surgical model. J Anesth 2009; 23:624-7. [PMID: 19921382 DOI: 10.1007/s00540-009-0792-x] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2009] [Accepted: 05/11/2009] [Indexed: 11/30/2022]
Abstract
Lipopolysaccharide (LPS) is an endotoxin known to induce disseminated intravascular coagulation and multiple organ failure followed by septic shock in animals. Nafamostat is a synthetic protease inhibitor with anticoagulant effects. This study investigated the effect of systemic administration of nafamostat on thermogenic homeostasis and survival time in a mouse surgical model. Male C57Bl/6 mice were anesthetized with sevoflurane and implanted with intraabdominal telemetry transmitters. Following the surgery, three groups of animals were administered Escherichia coli LPS (0127: B8) subcutaneously at doses of 0.3, 1.0, or 3.0 mg kg(-1), and one group received saline without LPS. Three other groups received 3 mg.kg(-1) LPS with 1, 3, or 10 mg kg(-1) of nafamostat. In another group 10 mg kg(-1)1 of nafamostat only was administered. The times to the onset of hypothermia (body temperature < 30 degrees C) and death were determined. L LPS significantly shortened the duration of both normothermia and survival, and nafamostat prolonged the normothermic periods that were reduced b 3 mg.kg(-1) LPS. Survival time was significantly correlated with the duration of normothermia (n = 48; r (2) = 0.779; P < 0.000001). The results demonstrated the effect of systemic administration of nafamostat against LPS-induced hypothermia. Nafamostat prevented hypothermia, and the consequent normal thermoregulation may have prolonged the survival period.
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Affiliation(s)
- Yushi U Adachi
- Intensive Care Unit of University Hospital, Hamamatsu University School of Medicine, Higashi-ku, Hamamatsu city, Japan
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Itagaki T, Katoh H, Adachi YU, Suzuki K, Obata Y, Doi M, Sato S. Hemothorax resulting from venous tearing by a catheter. J Anesth 2009; 23:636. [DOI: 10.1007/s00540-009-0811-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2009] [Accepted: 06/18/2009] [Indexed: 12/27/2022]
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Adachi Y, Itagaki T, Suzuki K, Uchisaki S, Kimura K, Obata Y, Doi M, Sato S. [Multiple difficulties for central venous access required the distal femoral vein catheterization: a case report]. Masui 2009; 58:913-916. [PMID: 19618836] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
The low femoral approach for catheterization of the central venous line is a difficult procedure because the surface landmark technique is not helpful. We report a case of patient who required the distal femoral cannulation. Re-catheter cannulation was planned for the patient after the major cardiovascular surgery. The right internal jugular vein showed the venous thrombus attributed to the previous catheter placement for the operation. The left internal, jugular vein had anatomical anomaly at the level of cricoid cartilage and the last approach for cannulation was not feasible. The right subclavian and right femoral regions were scarred with the surgical procedure. Finally, we performed the distal femoral cannulation using real time ultrasound guidance. When multiple difficulties for venous access are present, ultrasound-guided low approach of femoral vein might be one of the solutions.
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Affiliation(s)
- Yushi Adachi
- Intensive Care Unit of University Hospital, Hamamatsu University School of Medicine, Hamamatsu 431-3192
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Adachi YU, Uchisaki S, Suzuki K, Itagaki T, Obata Y, Doi M, Sato S. Radial artery cannulation using the Insyte-A device with ultrasound assistance. J Anesth 2009; 23:304-5. [DOI: 10.1007/s00540-008-0715-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2008] [Accepted: 11/06/2008] [Indexed: 11/28/2022]
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Mizuta K, Aoki Y, Suto A, Ootani K, Katsushima N, Itagaki T, Ohmi A, Okamoto M, Nishimura H, Matsuzaki Y, Hongo S, Sugawara K, Shimizu H, Ahiko T. Cross-antigenicity among EV71 strains from different genogroups isolated in Yamagata, Japan, between 1990 and 2007. Vaccine 2009; 27:3153-8. [DOI: 10.1016/j.vaccine.2009.03.060] [Citation(s) in RCA: 80] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2008] [Revised: 03/16/2009] [Accepted: 03/23/2009] [Indexed: 10/20/2022]
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Adachi Y, Suzuki K, Itagaki T, Obata Y, Doi M, Sato S. [Two cases of anesthesia mumps in the upper parotid gland after general anesthesia in the lateral position]. Masui 2008; 57:1150-1152. [PMID: 18807905] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
We describe two cases of acute transient swelling of the upper side of parotid glands of the patients after general anesthesia in the lateral position. The serum amylase levels in the patients were not increased and the enlargement of the parotid gland was diagnosed as anesthesia mumps. Previous reports suggested that mechanical compression might produce the swelling of the secreting organ, but our patients showed temporal parotid enlargement in the upper free side. Although, pre-medication with atropine might become a cause of parotid gland swelling, we anesthetized these patients without anti-cholinergic drugs. Procedures of oro-tracheal intubation and stimuli of endotracheal tube may induce impairment of the normal flow of saliva and lead to enlargement of the parotid gland.
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Affiliation(s)
- Yushi Adachi
- Intensive Care Unit of University Hospital, Hamamatsu University School of Medicine, Hamamatsu 431-3192
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