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Hongo T, Yumoto T, Inaba M, Taito S, Yorifuji T, Nakao A, Naito H. Long-term, patient-centered, frailty-based outcomes of older critical illness survivors from the emergency department: a post hoc analysis of the LIFE Study. BMC Geriatr 2024; 24:257. [PMID: 38491464 PMCID: PMC10941380 DOI: 10.1186/s12877-024-04881-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2023] [Accepted: 03/08/2024] [Indexed: 03/18/2024] Open
Abstract
BACKGROUND Evidence indicates frailty before intensive care unit (ICU) admission leads to poor outcomes. However, it is unclear whether quality of life (QOL) and activities of daily living (ADL) for survivors of critical illness admitted to the ICU via the emergency department remain consistent or deteriorate in the long-term compared to baseline. This study aimed to evaluate long-term QOL/ADL outcomes in these patients, categorized by the presence or absence of frailty according to Clinical Frailty Scale (CFS) score, as well as explore factors that influence these outcomes. METHODS This was a post-hoc analysis of a prospective, multicenter, observational study conducted across Japan. It included survivors aged 65 years or older who were admitted to the ICU through the emergency department. Based on CFS scores, participants were categorized into either the not frail group or the frail group, using a threshold CFS score of < 4. Our primary outcome was patient-centered outcomes (QOL/ADL) measured by the five-level EuroQol five-dimensional questionnaire (EQ-5D-5L) and the Barthel Index six months post-ICU admission, comparing results from baseline. Secondary outcomes included exploration of factors associated with QOL/ADL six months post-ICU admission using multiple linear regression analyses. RESULTS Of 514 candidates, 390 participants responded to the EQ-5D-5L questionnaire, while 237 responded to the Barthel Index. At six months post-admission, mean EQ-5D-5L values declined in both the not frail and frail groups (0.80 to 0.73, p = 0.003 and 0.58 to 0.50, p = 0.002, respectively); Barthel Index scores also declined in both groups (98 to 83, p < 0.001 and 79 to 61, p < 0.001, respectively). Multiple linear regression analysis revealed that baseline frailty (β coefficient, -0.15; 95% CI, - 0.23 to - 0.07; p < 0.001) and pre-admission EQ-5D-5L scores (β coefficient, 0.14; 95% CI, 0.02 to 0.26; p = 0.016) affected EQ-5D-5L scores at six months. Similarly, baseline frailty (β coefficient, -12.3; 95% CI, - 23.9 to - 0.80; p = 0.036) and Barthel Index scores (β coefficient, 0.54; 95% CI, 0.30 to 0.79; p < 0.001) influenced the Barthel Index score at six months. CONCLUSIONS Regardless of frailty, older ICU survivors from the emergency department were more likely to experience reduced QOL and ADL six months after ICU admission compared to baseline.
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Affiliation(s)
- Takashi Hongo
- Department of Emergency, Critical Care, and Disaster Medicine, Faculty of Medicine, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama University, 2-5-1 Shikata-cho, Kita-ku, Okayama, 700-8558, Japan
| | - Tetsuya Yumoto
- Department of Emergency, Critical Care, and Disaster Medicine, Faculty of Medicine, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama University, 2-5-1 Shikata-cho, Kita-ku, Okayama, 700-8558, Japan.
| | - Mototaka Inaba
- Department of Emergency, Critical Care, and Disaster Medicine, Faculty of Medicine, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama University, 2-5-1 Shikata-cho, Kita-ku, Okayama, 700-8558, Japan
| | - Shunsuke Taito
- Department of Clinical Practice and Support, Hiroshima University Hospital, 1-2-3 Minamiku Kasumi, Hiroshima, 734-0037, Japan
| | - Takashi Yorifuji
- Department of Epidemiology, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, 2-5-1 Shikata-cho, Kita-ku, Okayama, 700-8558, Japan
| | - Atsunori Nakao
- Department of Emergency, Critical Care, and Disaster Medicine, Faculty of Medicine, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama University, 2-5-1 Shikata-cho, Kita-ku, Okayama, 700-8558, Japan
| | - Hiromichi Naito
- Department of Emergency, Critical Care, and Disaster Medicine, Faculty of Medicine, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama University, 2-5-1 Shikata-cho, Kita-ku, Okayama, 700-8558, Japan
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Aoshima K, Obara T, Nojima T, Nakao A. Schmorl's Node Found with Acute Lower Back Pain. Intern Med 2024; 63:759-760. [PMID: 37407455 PMCID: PMC10982015 DOI: 10.2169/internalmedicine.2203-23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Accepted: 05/29/2023] [Indexed: 07/07/2023] Open
Affiliation(s)
- Kenji Aoshima
- Department of Emergency, Critical Care, and Disaster Medicine, Faculty of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama University, Japan
| | - Takafumi Obara
- Department of Emergency, Critical Care, and Disaster Medicine, Faculty of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama University, Japan
| | - Tsuyoshi Nojima
- Department of Emergency, Critical Care, and Disaster Medicine, Faculty of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama University, Japan
| | - Atsunori Nakao
- Department of Emergency, Critical Care, and Disaster Medicine, Faculty of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama University, Japan
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Hongo T, Naito H, Liu K, Murakami Y, Nozaki S, Maeyama H, Matsuoka A, Dote H, Inaba K, Miike S, Fujitani S, Hiraoka T, Obara T, Nojima T, Nakao A, Yumoto T. Changes in temporal muscle dimensions and their clinical impact in out-of-hospital cardiac arrest survivors. Resusc Plus 2024; 17:100527. [PMID: 38188596 PMCID: PMC10770543 DOI: 10.1016/j.resplu.2023.100527] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2023] [Revised: 11/13/2023] [Accepted: 11/29/2023] [Indexed: 01/09/2024] Open
Abstract
Objective This study investigates temporal muscle atrophy in out-of-hospital cardiac arrest patients post-resuscitation, seeking associations with neurological outcomes and factors associated with atrophy. Methods Using data from six Japanese intensive care units, adult patients' post-resuscitation who underwent head computed tomography scans on admission and two to five days post-admission were assessed. Temporal muscle area, thickness, and density were quantified from a single cross-sectional image. Patients were categorized into 'atrophy' or 'no atrophy' groups based on median daily temporal muscle atrophy rates. The primary outcome was changes in temporal muscle dimensions between admission and follow-up two to five days later. Secondary outcomes included assessing the impact of temporal muscle atrophy on 30-day survival, as well as identifying any clinical factors associated with temporal muscle atrophy. Results A total of 185 patients were analyzed. Measurements at follow-up revealed significant decreases in temporal muscle area (214 vs. 191 mm2, p < 0.001), thickness (4.9 vs. 4.7 mm, p < 0.001), and density (46 vs. 44 HU, p < 0.001) compared to those at admission. The median daily rate for temporal muscle area atrophy was 2.0% per day. There was no significant association between temporal muscle atrophy and 30-day survival (hazard ratios, 0.71; 95% CI, 0.41-1.23, p = 0.231). Multivariable logistic regression found no clinical factors significantly associated with temporal muscle atrophy. Conclusions Temporal muscle atrophy in post-resuscitation patients occurs rapidly at 2.0% per day. However, there was no significant association with 30-day mortality or any identified clinical factors. Further investigation into its long-term functional implications is warranted.
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Affiliation(s)
- Takashi Hongo
- Department of Emergency, Critical Care, and Disaster Medicine, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, 2-5-1 Shikata-cho, Okayama Kita-ku, Okayama 700-8558, Japan
- Department of Emergency, Okayama Saiseikai General Hospital, 2-25 Kokutai-cho, Okayama Kita-ku, Okayama 700-8511, Japan
| | - Hiromichi Naito
- Department of Emergency, Critical Care, and Disaster Medicine, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, 2-5-1 Shikata-cho, Okayama Kita-ku, Okayama 700-8558, Japan
| | - Keibun Liu
- Critical Care Research Group, The Prince Charles Hospital, 627 Rode Rd, Chermside, Brisbane, QLD 4032, Australia
- Institute for Molecular Bioscience, The University of Queensland, 306 Carmody Road, St Lucia, Brisbane, QLD 4072, Australia
- Non-Profit Organization ICU Collaboration Network (ICON), 2-15-13 Hongo, Bunkyo-ku, Tokyo, Japan
| | - Yuya Murakami
- Department of Emergency, Critical Care, and Disaster Medicine, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, 2-5-1 Shikata-cho, Okayama Kita-ku, Okayama 700-8558, Japan
- Department of Emergency and Critical Care Medicine, Tsuyama Chuo Hospital, 1756, Tsuyama, Okayama 708-0841, Japan
| | - Satoshi Nozaki
- Department of Emergency, Okayama Saiseikai General Hospital, 2-25 Kokutai-cho, Okayama Kita-ku, Okayama 700-8511, Japan
| | - Hiroki Maeyama
- Department of Emergency and Critical Care Medicine, Tsuyama Chuo Hospital, 1756, Tsuyama, Okayama 708-0841, Japan
| | - Ayaka Matsuoka
- Emergency and Critical Care Medicine, Saga University Hospital, 5-1-1 Nabeshima, Saga City, Saga 849-8501, Japan
| | - Hisashi Dote
- Department of Emergency and Critical Care Medicine, Seirei Hamamatsu General Hospital, 2-12-12 Sumiyoshi, Hamamatsu Naka-ku, Shizuoka 430-8558, Japan
| | - Kazumasa Inaba
- Department of Emergency and Critical Care Medicine, Seirei Hamamatsu General Hospital, 2-12-12 Sumiyoshi, Hamamatsu Naka-ku, Shizuoka 430-8558, Japan
| | - Satoshi Miike
- Emergency/Critical Care Medicine Department, St. Marianna Medical School, 2-16-1 Sugao Miyamae-ku, 216-8511 Kawasaki City, Kanagawa, Japan
| | - Shigeki Fujitani
- Emergency/Critical Care Medicine Department, St. Marianna Medical School, 2-16-1 Sugao Miyamae-ku, 216-8511 Kawasaki City, Kanagawa, Japan
| | - Tomohiro Hiraoka
- Department of Emergency, Critical Care, and Disaster Medicine, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, 2-5-1 Shikata-cho, Okayama Kita-ku, Okayama 700-8558, Japan
| | - Takafumi Obara
- Department of Emergency, Critical Care, and Disaster Medicine, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, 2-5-1 Shikata-cho, Okayama Kita-ku, Okayama 700-8558, Japan
| | - Tsuyoshi Nojima
- Department of Emergency, Critical Care, and Disaster Medicine, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, 2-5-1 Shikata-cho, Okayama Kita-ku, Okayama 700-8558, Japan
| | - Atsunori Nakao
- Department of Emergency, Critical Care, and Disaster Medicine, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, 2-5-1 Shikata-cho, Okayama Kita-ku, Okayama 700-8558, Japan
| | - Tetsuya Yumoto
- Department of Emergency, Critical Care, and Disaster Medicine, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, 2-5-1 Shikata-cho, Okayama Kita-ku, Okayama 700-8558, Japan
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Ohira A, Maki J, Ageta K, Nakato H, Oba H, Mitoma T, Mishima S, Tani K, Kirino S, Eto E, Nakao A, Masuyama H. Assessing the efficacy of simulation-based education for paramedics in extended focused assessment with sonography for trauma under physician guidance. Sci Rep 2024; 14:4190. [PMID: 38378769 PMCID: PMC10879516 DOI: 10.1038/s41598-024-54779-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2023] [Accepted: 02/16/2024] [Indexed: 02/22/2024] Open
Abstract
We investigated the effectiveness of simulation-based education in Focused Assessment with Sonography for Trauma (FAST) to increase the number of Emergency Medical Technicians (EMTs) capable of performing ultrasound examinations in vehicles under the guidance of a physician. Twenty-eight paramedics watched a 14-min video on the features of the ultrasound system, its use, and the scanning method for each part of the body. Each participant performed four FAST examinations using a portable ultrasound device, and the task performance was rated using the Task Specific Checklist (TSC) and Global Rating Scale (GRS). The time required for visualizing each examination site and each FAST was assessed. The mean time required for the first and fourth FAST was 144.6 ± 52.4 s and 90.5 ± 31.0 s, respectively. The time required for each test significantly decreased with repeated testing (p < 0.001). The time to complete FAST was significantly shortened for the pericardial cavity (33.4 ± 23.1/15.3 ± 10.6 s, p < 0.01), right thoracic cavity (25.2 ± 11.8/12.1 ± 8.3 s, p < 0.01), Morrison fossa (19.1 ± 10.8/10.8 ± 6.3 s, p < 0.05), and left thoracic cavity (19.0 ± 8.3/15.6 ± 8.3 s, p < 0.05). TSC and GRS scores were elevated, and all EMTs could obtain valid images. The combination of a brief video lecture and hands-on training significantly reduced the time required for FAST performance. Moreover, repeated practice enabled the EMTs to efficiently obtain accurate and clinically useful images.
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Affiliation(s)
- Akiko Ohira
- Department of Obstetrics and Gynecology, and Department of Emergency and Disaster Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, 2-5-1 Shikada-Cho, Kita-Ku, Okayama-Shi, Okayama, Japan
| | - Jota Maki
- Department of Obstetrics and Gynecology, and Department of Emergency and Disaster Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, 2-5-1 Shikada-Cho, Kita-Ku, Okayama-Shi, Okayama, Japan.
| | - Kohei Ageta
- Department of Obstetrics and Gynecology, and Department of Emergency and Disaster Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, 2-5-1 Shikada-Cho, Kita-Ku, Okayama-Shi, Okayama, Japan
| | - Hikari Nakato
- Department of Obstetrics and Gynecology, and Department of Emergency and Disaster Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, 2-5-1 Shikada-Cho, Kita-Ku, Okayama-Shi, Okayama, Japan
| | - Hikaru Oba
- Department of Obstetrics and Gynecology, and Department of Emergency and Disaster Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, 2-5-1 Shikada-Cho, Kita-Ku, Okayama-Shi, Okayama, Japan
| | - Tomohiro Mitoma
- Department of Obstetrics and Gynecology, and Department of Emergency and Disaster Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, 2-5-1 Shikada-Cho, Kita-Ku, Okayama-Shi, Okayama, Japan
| | - Sakurako Mishima
- Department of Obstetrics and Gynecology, and Department of Emergency and Disaster Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, 2-5-1 Shikada-Cho, Kita-Ku, Okayama-Shi, Okayama, Japan
| | - Kazumasa Tani
- Department of Obstetrics and Gynecology, and Department of Emergency and Disaster Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, 2-5-1 Shikada-Cho, Kita-Ku, Okayama-Shi, Okayama, Japan
| | - Satoe Kirino
- Department of Obstetrics and Gynecology, and Department of Emergency and Disaster Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, 2-5-1 Shikada-Cho, Kita-Ku, Okayama-Shi, Okayama, Japan
| | - Eriko Eto
- Department of Obstetrics and Gynecology, and Department of Emergency and Disaster Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, 2-5-1 Shikada-Cho, Kita-Ku, Okayama-Shi, Okayama, Japan
| | - Atsunori Nakao
- Department of Obstetrics and Gynecology, and Department of Emergency and Disaster Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, 2-5-1 Shikada-Cho, Kita-Ku, Okayama-Shi, Okayama, Japan
| | - Hisashi Masuyama
- Department of Obstetrics and Gynecology, and Department of Emergency and Disaster Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, 2-5-1 Shikada-Cho, Kita-Ku, Okayama-Shi, Okayama, Japan
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Hongo T, Yumoto T, Kosaki Y, Hiraoka T, Tsukahara K, Nojima T, Obara T, Ageta K, Yamasaki Y, Taniguchi K, Miura M, Miyaishi S, Naito H, Nakao A. Successful Cardiac, Lung, and Kidney Transplantation from a Methanol-poisoned Donor. JMA J 2024; 7:133-135. [PMID: 38314411 PMCID: PMC10834169 DOI: 10.31662/jmaj.2023-0081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Accepted: 10/24/2023] [Indexed: 02/06/2024] Open
Abstract
Massive methanol exposure can lead to severe and detrimental effects that can result in death or brain death. As organs from patients with brain death after methanol ingestion are less likely to be recovered, these patients have been considered marginal donors. We present a case of successful multiple organ transplantation (heart, lungs, and kidneys) from a methanol-poisoned patient. Our experience illustrates that donor death from methanol intoxication does not preclude organ transplantation.
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Affiliation(s)
- Takashi Hongo
- Department of Emergency, Critical Care, and Disaster Medicine, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama, Japan
| | - Tetsuya Yumoto
- Department of Emergency, Critical Care, and Disaster Medicine, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama, Japan
| | - Yoshinori Kosaki
- Department of Emergency, Critical Care, and Disaster Medicine, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama, Japan
| | - Tomohiro Hiraoka
- Department of Emergency, Critical Care, and Disaster Medicine, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama, Japan
| | - Kohei Tsukahara
- Department of Emergency, Critical Care, and Disaster Medicine, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama, Japan
| | - Tsuyoshi Nojima
- Department of Emergency, Critical Care, and Disaster Medicine, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama, Japan
| | - Takafumi Obara
- Department of Emergency, Critical Care, and Disaster Medicine, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama, Japan
| | - Kohei Ageta
- Department of Emergency, Critical Care, and Disaster Medicine, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama, Japan
| | - Yukie Yamasaki
- Department of Legal Medicine, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama, Japan
| | - Kaori Taniguchi
- Department of Legal Medicine, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama, Japan
| | - Masanobu Miura
- Department of Legal Medicine, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama, Japan
- Department of Legal Medicine, Kawasaki Medical School, Kurashiki, Japan
| | - Satoru Miyaishi
- Department of Legal Medicine, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama, Japan
| | - Hiromichi Naito
- Department of Emergency, Critical Care, and Disaster Medicine, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama, Japan
| | - Atsunori Nakao
- Department of Emergency, Critical Care, and Disaster Medicine, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama, Japan
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Obara T, Naito H, Nojima T, Hirayama T, Hongo T, Ageta K, Aokage T, Hisamura M, Yumoto T, Nakao A. Hydrogen in Transplantation: Potential Applications and Therapeutic Implications. Biomedicines 2024; 12:118. [PMID: 38255223 PMCID: PMC10813693 DOI: 10.3390/biomedicines12010118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2023] [Revised: 12/25/2023] [Accepted: 01/02/2024] [Indexed: 01/24/2024] Open
Abstract
Hydrogen gas, renowned for its antioxidant properties, has emerged as a novel therapeutic agent with applications across various medical domains, positioning it as a potential adjunct therapy in transplantation. Beyond its antioxidative properties, hydrogen also exerts anti-inflammatory effects by modulating pro-inflammatory cytokines and signaling pathways. Furthermore, hydrogen's capacity to activate cytoprotective pathways bolsters cellular resilience against stressors. In recent decades, significant advancements have been made in the critical medical procedure of transplantation. However, persistent challenges such as ischemia-reperfusion injury (IRI) and graft rejection continue to hinder transplant success rates. This comprehensive review explores the potential applications and therapeutic implications of hydrogen in transplantation, shedding light on its role in mitigating IRI, improving graft survival, and modulating immune responses. Through a meticulous analysis encompassing both preclinical and clinical studies, we aim to provide valuable insights into the promising utility of hydrogen as a complementary therapy in transplantation.
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Affiliation(s)
| | - Hiromichi Naito
- Department of Emergency, Critical Care, and Disaster Medicine, Faculty of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama University, 2-5-1 Shikata-cho, Kita-ku, Okayama 700-8558, Japan; (T.O.); (T.N.); (T.H.); (T.H.); (K.A.); (T.A.); (M.H.); (T.Y.); (A.N.)
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Kosaki Y, Hongo T, Hayakawa M, Kudo D, Kushimoto S, Tagami T, Naito H, Nakao A, Yumoto T. Association of initial lactate levels and red blood cell transfusion strategy with outcomes after severe trauma: a post hoc analysis of the RESTRIC trial. World J Emerg Surg 2024; 19:1. [PMID: 38167057 PMCID: PMC10763143 DOI: 10.1186/s13017-023-00530-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2023] [Accepted: 12/19/2023] [Indexed: 01/05/2024] Open
Abstract
BACKGROUND The appropriateness of a restrictive transfusion strategy for those with active bleeding after traumatic injury remains uncertain. Given the association between tissue hypoxia and lactate levels, we hypothesized that the optimal transfusion strategy may differ based on lactate levels. This post hoc analysis of the RESTRIC trial sought to investigate the association between transfusion strategies and patient outcomes based on initial lactate levels. METHODS We performed a post hoc analysis of the RESTRIC trial, a cluster-randomized, crossover, non-inferiority multicenter trials, comparing a restrictive and liberal red blood cell transfusion strategy for adult trauma patients at risk of major bleeding. This was conducted during the initial phase of trauma resuscitation; from emergency department arrival up to 7 days after hospital admission or intensive care unit (ICU) discharge. Patients were grouped by lactate levels at emergency department arrival: low (< 2.5 mmol/L), middle (≥ 2.5 and < 4.0 mmol/L), and high (≥ 4.0 mmol/L). We compared 28 days mortality and ICU-free and ventilator-free days using multiple linear regression among groups. RESULTS Of the 422 RESTRIC trial participants, 396 were analyzed, with low (n = 131), middle (n = 113), and high (n = 152) lactate. Across all lactate groups, 28 days mortality was similar between strategies. However, in the low lactate group, the restrictive approach correlated with more ICU-free (β coefficient 3.16; 95% CI 0.45 to 5.86) and ventilator-free days (β coefficient 2.72; 95% CI 0.18 to 5.26) compared to the liberal strategy. These findings persisted even after excluding patients with severe traumatic brain injury. CONCLUSIONS Our results suggest that restrictive transfusion strategy might not have a significant impact on 28-day survival rates, regardless of lactate levels. However, the liberal transfusion strategy may lead to shorter ICU- and ventilator-free days for patients with low initial blood lactate levels.
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Affiliation(s)
- Yoshinori Kosaki
- Department of Emergency, Critical Care, and Disaster Medicine, Faculty of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama University, 2-5-1 Shikata-cho, Kita-ku, Okayama, 700-8558, Japan
| | - Takashi Hongo
- Department of Emergency, Critical Care, and Disaster Medicine, Faculty of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama University, 2-5-1 Shikata-cho, Kita-ku, Okayama, 700-8558, Japan
| | - Mineji Hayakawa
- Department of Emergency Medicine, Hokkaido University Hospital, N14W5 Kita-ku, Sapporo, 060-8648, Japan
| | - Daisuke Kudo
- Division of Emergency and Critical Care Medicine, Tohoku University Graduate School of Medicine, 1-1 Seiryo-Machi, Aoba-ku, Sendai, 980-8574, Japan
| | - Shigeki Kushimoto
- Division of Emergency and Critical Care Medicine, Tohoku University Graduate School of Medicine, 1-1 Seiryo-Machi, Aoba-ku, Sendai, 980-8574, Japan
| | - Takashi Tagami
- Department of Emergency and Critical Care Medicine, Nippon Medical School Musashi Kosugi Hospital, 1-396 Kosugimachi, Nakahara-ku, Kawasaki, Kanagawa, 211-8533, Japan
| | - Hiromichi Naito
- Department of Emergency, Critical Care, and Disaster Medicine, Faculty of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama University, 2-5-1 Shikata-cho, Kita-ku, Okayama, 700-8558, Japan
| | - Atsunori Nakao
- Department of Emergency, Critical Care, and Disaster Medicine, Faculty of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama University, 2-5-1 Shikata-cho, Kita-ku, Okayama, 700-8558, Japan
| | - Tetsuya Yumoto
- Department of Emergency, Critical Care, and Disaster Medicine, Faculty of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama University, 2-5-1 Shikata-cho, Kita-ku, Okayama, 700-8558, Japan.
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Naito H, Hongo T, Yumoto T, Maeyama H, Nakao A. Reply to: Stomach inflation during cardiopulmonary resuscitation in out-of-hospital cardiac arrest patients: Where did the air go? Resuscitation 2024; 194:110099. [PMID: 38135016 DOI: 10.1016/j.resuscitation.2023.110099] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2023] [Accepted: 12/14/2023] [Indexed: 12/24/2023]
Affiliation(s)
- Hiromichi Naito
- Department of Emergency, Critical Care, and Disaster Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan; Emergency and Critical Care Center, Tsuyama Chuo Hospital, Tsuyama, Japan.
| | - Takashi Hongo
- Department of Emergency, Critical Care, and Disaster Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Tetsuya Yumoto
- Department of Emergency, Critical Care, and Disaster Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Hiroki Maeyama
- Emergency and Critical Care Center, Tsuyama Chuo Hospital, Tsuyama, Japan
| | - Atsunori Nakao
- Department of Emergency, Critical Care, and Disaster Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
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Tanabe R, Hongo T, Obara T, Nojima T, Nakao A, Elmer J, Naito H, Yumoto T. Treatment patterns and clinician stress related to care of out-of-hospital cardiac arrest patients with a do not attempt resuscitation order. Resusc Plus 2023; 16:100507. [PMID: 38026140 PMCID: PMC10665952 DOI: 10.1016/j.resplu.2023.100507] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2023] [Revised: 10/25/2023] [Accepted: 11/01/2023] [Indexed: 12/01/2023] Open
Abstract
Objective This research investigated treatment patterns for out-of-hospital cardiac arrest patients with Do Not Attempt Resuscitation orders in Japanese emergency departments and the associated clinician stress. Methods A cross-sectional survey was conducted at 9 hospitals in Okayama, Japan, targeting emergency department nurses and physicians. The questionnaire inquired about the last treated out-of-hospital cardiac arrest patient with a Do Not Attempt Resuscitation. We assessed emotional stress on a 0-10 scale and moral distress on a 1-5 scale among clinicians. Results Of 208 participants, 107 (51%) had treated an out-of-hospital cardiac arrest patient with a Do Not Attempt Resuscitation order in the past 6 months. Of these, 65 (61%) clinicians used a "slow code" due to perceived futility in resuscitation (42/65 [65%]), unwillingness to terminate resuscitation upon arrival (38/65 [59%]), and absence of family at the time of patient's arrival (35/65 [54%]). Female clinicians had higher emotional stress (5 vs. 3; P = 0.007) and moral distress (3 vs. 2; P = 0.002) than males. Nurses faced more moral distress than physicians (3 vs. 2; P < 0.001). Adjusted logistic regression revealed that having performed a "slow code" (adjusted odds ratio, 5.09 [95% CI, 1.68-17.87]) and having greater ethical concerns about "slow code" (adjusted odds ratio, 0.35 [95% CI, 0.19-0.58]) were associated with high stress levels. Conclusions The prevalent use of "slow code" for out-of-hospital cardiac arrest patients with Do Not Attempt Resuscitation orders underscores the challenges in managing these patients in clinical practice.
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Affiliation(s)
- Ryo Tanabe
- Department of Emergency, Critical Care, and Disaster Medicine, Faculty of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama University, Okayama, Japan
| | - Takashi Hongo
- Department of Emergency, Critical Care, and Disaster Medicine, Faculty of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama University, Okayama, Japan
| | - Takafumi Obara
- Department of Emergency, Critical Care, and Disaster Medicine, Faculty of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama University, Okayama, Japan
| | - Tsuyoshi Nojima
- Department of Emergency, Critical Care, and Disaster Medicine, Faculty of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama University, Okayama, Japan
| | - Atsunori Nakao
- Department of Emergency, Critical Care, and Disaster Medicine, Faculty of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama University, Okayama, Japan
| | - Jonathan Elmer
- Department of Emergency Medicine, University of Pittsburgh, Pittsburgh, PA, USA
- Department of Critical Care Medicine, University of Pittsburgh, Pittsburgh, PA, USA
- Department of Neurology, University of Pittsburgh, Pittsburgh, PA, USA
| | - Hiromichi Naito
- Department of Emergency, Critical Care, and Disaster Medicine, Faculty of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama University, Okayama, Japan
| | - Tetsuya Yumoto
- Department of Emergency, Critical Care, and Disaster Medicine, Faculty of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama University, Okayama, Japan
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Yumoto T, Aokage T, Hirayama T, Yamamoto H, Obara T, Nojima T, Naito H, Nakao A. Hydrogen gas treatment improves survival in a rat model of crush syndrome by ameliorating rhabdomyolysis. EUR J INFLAMM 2023. [DOI: 10.1177/1721727x231168547] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/31/2023] Open
Abstract
Objectives Crush syndrome (CS) is characterized by a systemic manifestation of traumatic rhabdomyolysis, leading to multiple organ dysfunction and death. Ischemia-reperfusion (IR) injury is commonly responsible for systemic response. Extending studies have shown that hydrogen gas treatment ameliorated IR injury in numerous experimental models; however, its effect on CS has not been well examined. This study aimed to investigate the effects of hydrogen gas inhalation following crush injury in an experimental model of CS. Methods Male Sprague-Dawley rats were subjected to experimental CS by applying a total of 3.0 kg weight to both hindlimb under general anesthesia for 6 h. Immediately after decompression, the animals were randomly placed in a gas chamber filled with either air or 1.3% hydrogen gas. Animals were sacrificed 18 h or 24 h following gas exposure for non-survival studies or for survival study, respectively. Results The rats with hydrogen treatment ( n = 6) had a higher 24-h survival than the rats with air treatment ( n = 9) (100% vs. 44%, p = 0.035). Lactate concentrations (2.9 ± 0.2 vs. 2.2 ± 0.2 mmol/L, p = 0.040) and creatine kinase (34,178 ± 13,580 vs. 5005 ± 842 IU/L, p = 0.016) were lower in the hydrogen group compared with the air group 18 h after decompression ( n = 4 in the air group, and n = 5 in the H2 group). Histological analysis revealed that the damage to the rectus femoris muscle and kidney appeared to be ameliorated by hydrogen treatment. Conclusion Hydrogen gas inhalation may be a promising therapeutic approach in the treatment of CS.
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Yumoto T, Hongo T, Koide Y, Obara T, Tsukahara K, Naito H, Nakao A. Radiation in an emergency situation: attempting to respect the patient's beliefs as reported by a minor. BMC Med Ethics 2023; 24:80. [PMID: 37794408 PMCID: PMC10552384 DOI: 10.1186/s12910-023-00962-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Accepted: 09/25/2023] [Indexed: 10/06/2023] Open
Abstract
BACKGROUND Each individual's unique health-related beliefs can greatly impact the patient-clinician relationship. When there is a conflict between the patient's preferences and recommended medical care, it can create a serious ethical dilemma, especially in an emergency setting, and dramatically alter this important relationship. CASE PRESENTATION A 56-year-old man, who remained comatose after out-of-hospital cardiac arrest, was rushed to our hospital. The patient was scheduled for emergency coronary angiography when his adolescent daughter reported that she and her father held sincere beliefs against radiation exposure. We were concerned that she did not fully understand the potential consequences if her father did not receive the recommended treatment. A physician provided her with in depth information regarding the risks and benefits of the treatment. While we did not want to disregard her statement, we opted to save the patient's life due to concerns about the validity of her report. CONCLUSIONS Variations in beliefs regarding medical care force clinicians to incorporate patient beliefs into medical practice. However, an emergency may require a completely different approach. When faced with a patient in a life-threatening condition and unconscious, we should take action to prioritize saving their life, unless we are highly certain about the validity of their advance directives.
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Affiliation(s)
- Tetsuya Yumoto
- Department of Emergency, Critical Care, and Disaster Medicine, Faculty of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama University, 2-5-1 Shikata-cho, Kita- ku, Okayama, 700-8558, Japan.
| | - Takashi Hongo
- Department of Emergency, Critical Care, and Disaster Medicine, Faculty of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama University, 2-5-1 Shikata-cho, Kita- ku, Okayama, 700-8558, Japan
| | - Yasuhiro Koide
- Department of Emergency, Critical Care, and Disaster Medicine, Faculty of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama University, 2-5-1 Shikata-cho, Kita- ku, Okayama, 700-8558, Japan
| | - Takafumi Obara
- Department of Emergency, Critical Care, and Disaster Medicine, Faculty of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama University, 2-5-1 Shikata-cho, Kita- ku, Okayama, 700-8558, Japan
| | - Kohei Tsukahara
- Department of Emergency, Critical Care, and Disaster Medicine, Faculty of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama University, 2-5-1 Shikata-cho, Kita- ku, Okayama, 700-8558, Japan
| | - Hiromichi Naito
- Department of Emergency, Critical Care, and Disaster Medicine, Faculty of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama University, 2-5-1 Shikata-cho, Kita- ku, Okayama, 700-8558, Japan
| | - Atsunori Nakao
- Department of Emergency, Critical Care, and Disaster Medicine, Faculty of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama University, 2-5-1 Shikata-cho, Kita- ku, Okayama, 700-8558, Japan
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12
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Nishimura T, Suga M, Hongo T, Yumoto T, Nakao A, Ishihara S, Naito H. Comparison of outcomes of out-of-hospital cardiac arrest patients: Emergency calls placed from mobile phones vs. landline phones. Resusc Plus 2023; 15:100434. [PMID: 37583510 PMCID: PMC10423887 DOI: 10.1016/j.resplu.2023.100434] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2023] [Revised: 07/11/2023] [Accepted: 07/13/2023] [Indexed: 08/17/2023] Open
Abstract
Background Until recently, calls to the emergency medical service (EMS) from landline phones, which display the caller's exact location at the dispatch center, had been common. Since the use of mobile phones has become widespread, many emergency calls are now made from mobile phones. Differences in outcomes of out-of-hospital cardiac arrest (OHCA) patients for whom EMS was called from mobile versus landline phones has not yet been fully elucidated. Methods We performed a retrospective, population-based analysis in Kobe, Japan to examine whether EMS calls from mobiles improved the prognosis of OHCA patients over EMS calls placed from landlines. The primary outcome was favorable neurological outcome, defined as Cerebral Performance Category (CPC) scores of 1 or 2 at discharge. Secondary outcomes were survival at one-month, survival at discharge, and time durations between call and EMS activities. Results Of 4,231 OHCA cases, 2,194 cases (706 landline cases vs. 1,488 mobile cases) were included in this study. The percentages of favorable neurological outcomes were 0.7% (5/706) in the landline group and 3.8% (56/1,488) in the mobile group. Adjusted multivariable logistic regression revealed that favorable neurological outcomes (odds ratio [OR] 3.03, 95% confidence interval [CI] 1.12-8.17, p = 0.03) were better in the mobile group, while one-month survival (OR 1.30, 95% CI 0.80-2.14, p = 0.29) was not significantly different. Bystander CPR was more frequently administered in the mobile group (landlines 61.3% vs. mobiles 68.4%, p < 0.01). Time durations between call to EMS dispatch (184.5 [IQR 157-220 s] vs. 205 [IQR 174-248 s], p < 0.01) and EMS arrival (476.5 [IQR 377-599 s] vs. 491 [IQR 407.5-611.5 s], p < 0.01) were shorter in the landline group. Conclusions Although the landline caller location display system seems effective for shorter times between EMS call and EMS arrival, mobile phone use was associated with better neurological outcomes.
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Affiliation(s)
- Takeshi Nishimura
- Department of Emergency, Critical Care, and Disaster Medicine, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Japan
- Department of Emergency and Critical Care Medicine, Hyogo Emergency Medical Center, Japan
| | - Masafumi Suga
- Department of Emergency, Critical Care, and Disaster Medicine, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Japan
- Department of Emergency and Critical Care Medicine, Hyogo Emergency Medical Center, Japan
| | - Takashi Hongo
- Department of Emergency, Critical Care, and Disaster Medicine, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Japan
| | - Tetsuya Yumoto
- Department of Emergency, Critical Care, and Disaster Medicine, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Japan
| | - Atsunori Nakao
- Department of Emergency, Critical Care, and Disaster Medicine, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Japan
| | - Satoshi Ishihara
- Department of Emergency and Critical Care Medicine, Hyogo Emergency Medical Center, Japan
| | - Hiromichi Naito
- Department of Emergency, Critical Care, and Disaster Medicine, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Japan
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Aokage T, Iketani M, Seya M, Meng Y, Ageta K, Naito H, Nakao A, Ohsawa I. Attenuation of pulmonary damage in aged lipopolysaccharide-induced inflammation mice through continuous 2 % hydrogen gas inhalation: A potential therapeutic strategy for geriatric inflammation and survival. Exp Gerontol 2023; 180:112270. [PMID: 37572992 DOI: 10.1016/j.exger.2023.112270] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2023] [Revised: 08/08/2023] [Accepted: 08/09/2023] [Indexed: 08/14/2023]
Abstract
INTRODUCTION With the global population aging, there is an increased prevalence of sepsis among the elderly, a demographic particularly susceptible to inflammation. This study aimed to evaluate the therapeutic potential of hydrogen gas, known for its anti-inflammatory and antioxidant properties, in attenuating inflammation specifically in the lungs and liver, and age-associated molecular markers in aged mice. METHODS Male mice aged 21 to 23 months, representative of the human elderly population, were subjected to inflammation via intraperitoneal injection of lipopolysaccharide (LPS). The mice were allocated into eight groups to examine the effects of varying durations and concentrations of hydrogen gas inhalation: control, saline without hydrogen, saline with 24-hour 2 % hydrogen, LPS without hydrogen, LPS with 24-hour 2 % hydrogen, LPS with 6-hour 2 % hydrogen, LPS with 1-hour 2 % hydrogen, and LPS with 24-hour 1 % hydrogen. Parameters assessed included survival rate, activity level, inflammatory biomarkers, and organ injury. RESULTS Extended administration of hydrogen gas specifically at a 2 % concentration for 24 h led to a favorable prognosis in the aged mice by reducing mRNA expression of inflammatory biomarkers in lung and liver tissue, mitigating lung injury, and diminishing the expression of the senescence-associated protein p21. Moreover, hydrogen gas inhalation selectively ameliorated senescence-related markers in lung tissue, including C-X-C motif chemokine 2, metalloproteinase-3, and arginase-1. Notably, hydrogen gas did not alleviate LPS-induced liver injury under the conditions tested. CONCLUSION The study highlights that continuous inhalation of hydrogen gas at a 2 % concentration for 24 h can be a potent intervention in the geriatric population for improving survival and physical activity by mitigating pulmonary inflammation and modulating senescence-related markers in aged mice with LPS-induced inflammation. This finding paves the way for future research into hydrogen gas as a therapeutic strategy to alleviate severe inflammation that can lead to organ damage in the elderly.
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Affiliation(s)
- Toshiyuki Aokage
- Department of Emergency, Critical Care and Disaster Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan; Biological Process of Aging, Tokyo Metropolitan Institute for Geriatrics and Gerontology, Tokyo, Japan.
| | - Masumi Iketani
- Biological Process of Aging, Tokyo Metropolitan Institute for Geriatrics and Gerontology, Tokyo, Japan
| | - Mizuki Seya
- Department of Emergency, Critical Care and Disaster Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Ying Meng
- Department of Emergency, Critical Care and Disaster Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Kohei Ageta
- Department of Emergency, Critical Care and Disaster Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Hiromichi Naito
- Department of Emergency, Critical Care and Disaster Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Atsunori Nakao
- Department of Emergency, Critical Care and Disaster Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Ikuroh Ohsawa
- Biological Process of Aging, Tokyo Metropolitan Institute for Geriatrics and Gerontology, Tokyo, Japan
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Inoue F, Hongo T, Ichiba T, Otani T, Naito H, Kosaki Y, Murakami Y, Iida A, Yumoto T, Naito H, Nakao A. Collapse-related traumatic intracranial hemorrhage following out-of-hospital cardiac arrest: A multicenter retrospective cohort study. Resusc Plus 2023; 15:100418. [PMID: 37416696 PMCID: PMC10319812 DOI: 10.1016/j.resplu.2023.100418] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2023] [Revised: 06/06/2023] [Accepted: 06/08/2023] [Indexed: 07/08/2023] Open
Abstract
Background Sudden loss of consciousness as a result of cardiac arrest can cause severe traumatic head injury. Collapse-related traumatic intracranial hemorrhage (CRTIH) following out-of-hospital cardiac arrest (OHCA) may be linked to poor neurological outcomes; however, there is a paucity of data on this entity. This study aimed to investigate the frequency, characteristics, and outcomes of CRTIH following OHCA. Methods Adult patients treated post-OHCA at 5 intensive care units who had head computed tomography (CT) scans were included in the study. CRTIH following OHCA was defined as a traumatic intracranial injury from collapse due to sudden loss of consciousness associated with OHCA. Patients with and without CRTIH were compared. The primary outcome assessed was the frequency of CRTIH following OHCA. Additionally, the clinical features, management, and consequences of CRTIH were analyzed descriptively. Results CRTIH following OHCA was observed in 8 of 345 enrolled patients (2.3%). CRTIH was more frequent after collapse outside the home, from a standing position, or due to cardiac arrest with a cardiac etiology. Intracranial hematoma expansion on follow up CT was seen in 2 patients; both received anticoagulant therapy, and one required surgical evacuation. Three patients (37.5%) with CRTIH had favorable neurological outcomes 28 days after collapse. Conclusions Despite its rare occurrence, physicians should pay special attention to CRTIH following OHCA during the post-resuscitation care period. Larger prospective studies are warranted to provide a more explicit picture of this clinical condition.
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Affiliation(s)
- Fumiya Inoue
- Department of Emergency Medicine, Hiroshima City Hospital, 7-33 Motomachi, Hiroshima Naka-ku, Hiroshima 730-8518, Japan
| | - Takashi Hongo
- Department of Emergency, Critical Care, and Disaster Medicine, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, 2-5-1 Shikata-cho, Okayama Kita-ku, Okayama 700-8558, Japan
- Department of Emergency, Okayama Saiseikai General Hospital, 2-25 Kokutai-cho, Okayama Kita-ku, Okayama 700-8511, Japan
| | - Toshihisa Ichiba
- Department of Emergency Medicine, Hiroshima City Hospital, 7-33 Motomachi, Hiroshima Naka-ku, Hiroshima 730-8518, Japan
| | - Takayuki Otani
- Department of Emergency Medicine, Hiroshima City Hospital, 7-33 Motomachi, Hiroshima Naka-ku, Hiroshima 730-8518, Japan
| | - Hiroshi Naito
- Department of Emergency Medicine, Hiroshima City Hospital, 7-33 Motomachi, Hiroshima Naka-ku, Hiroshima 730-8518, Japan
| | - Yoshinori Kosaki
- Department of Emergency, Critical Care, and Disaster Medicine, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, 2-5-1 Shikata-cho, Okayama Kita-ku, Okayama 700-8558, Japan
| | - Yuya Murakami
- Department of Emergency, Critical Care, and Disaster Medicine, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, 2-5-1 Shikata-cho, Okayama Kita-ku, Okayama 700-8558, Japan
- Department of Emergency and Critical Care Medicine, Tsuyama Chuo Hospital, 1756 Kawasaki, Tsuyama, Okayama 708-0841, Japan
| | - Atsuyoshi Iida
- Department of Emergency, Critical Care, and Disaster Medicine, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, 2-5-1 Shikata-cho, Okayama Kita-ku, Okayama 700-8558, Japan
- Department of Emergency Medicine, Japanese Red Cross Okayama Hospital, 2-1-1 Aoe, Okayama Kita-ku, Okayama 700-8607, Japan
| | - Tetsuya Yumoto
- Department of Emergency, Critical Care, and Disaster Medicine, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, 2-5-1 Shikata-cho, Okayama Kita-ku, Okayama 700-8558, Japan
| | - Hiromichi Naito
- Department of Emergency, Critical Care, and Disaster Medicine, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, 2-5-1 Shikata-cho, Okayama Kita-ku, Okayama 700-8558, Japan
| | - Atsunori Nakao
- Department of Emergency, Critical Care, and Disaster Medicine, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, 2-5-1 Shikata-cho, Okayama Kita-ku, Okayama 700-8558, Japan
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Sasanami M, Iida A, Iwamuro M, Hirai R, Obara T, Tsukahara K, Yumoto T, Naito H, Nakao A. An Unusual Presentation of Chest Pain and Laryngeal Discomfort in a Pregnant Woman: A Case Report and Literature Review. Acta Med Okayama 2023; 77:429-431. [PMID: 37635144 DOI: 10.18926/amo/65755] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 08/29/2023]
Abstract
Intramural esophageal dissection (IED), characterized by bleeding into the submucosal space, leads to mucosal separation and dissection. The most prevalent symptoms are sudden chest or retrosternal pain, hematemesis, and dysphagia. Therefore, acute coronary syndrome and aortic dissection are among its most notable differential diagnoses. A 31-year-old pregnant woman presented with acute chest pain, laryngeal discomfort, and hematemesis. Emergency esophagogastroscopy revealed longitudinal mucosal dissection (upper esophagus to esophagogastric junction). The patient was successfully treated by avoiding the ingestion of solid foods. Clinicians should consider a diagnosis of IED for pregnant patients with acute chest pain, especially if hematemesis is present.
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Affiliation(s)
- Misa Sasanami
- Department of Emergency, Critical Care and Disaster Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences
| | - Atsuyoshi Iida
- Department of Emergency, Critical Care and Disaster Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences
| | - Masaya Iwamuro
- Department of Gastroenterology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences
| | - Ryousuke Hirai
- Department of Gastroenterology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences
| | - Takashi Obara
- Department of Emergency, Critical Care and Disaster Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences
| | - Kohei Tsukahara
- Department of Emergency, Critical Care and Disaster Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences
| | - Tetsuya Yumoto
- Department of Emergency, Critical Care and Disaster Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences
| | - Hiromichi Naito
- Department of Emergency, Critical Care and Disaster Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences
| | - Atsunori Nakao
- Department of Emergency, Critical Care and Disaster Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences
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Ageta K, Hirayama T, Aokage T, Seya M, Meng Y, Nojima T, Yamamoto H, Obara T, Nakao A, Yumoto T, Tsukahara K, Naito H. Hydrogen inhalation attenuates lung contusion after blunt chest trauma in mice. Surgery 2023; 174:343-349. [PMID: 37210236 PMCID: PMC10193194 DOI: 10.1016/j.surg.2023.04.029] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2023] [Revised: 03/01/2023] [Accepted: 04/09/2023] [Indexed: 05/22/2023]
Abstract
BACKGROUND Lung contusion caused by blunt chest trauma evokes a severe inflammatory reaction in the pulmonary parenchyma that may be associated with acute respiratory distress syndrome. Although hydrogen gas has antioxidant and anti-inflammatory effects and is protective against multiple types of lung injury at safe concentrations, the effects of inhaled hydrogen gas on blunt lung injury have not been previously investigated. Therefore, using a mouse model, we tested the hypothesis that hydrogen inhalation after chest trauma would reduce pulmonary inflammation and acute lung injury associated with lung contusion. METHODS Inbred male C57BL/6 mice were randomly divided into 3 groups: sham with air inhalation, lung contusion with air inhalation, and lung contusion with 1.3% hydrogen inhalation. Experimental lung contusion was induced using a highly reproducible and standardized apparatus. Immediately after induction of lung contusion, mice were placed in a chamber exposed to 1.3% hydrogen gas in the air. Histopathological analysis and real-time polymerase chain reaction in lung tissue and blood gas analysis were performed 6 hours after contusion. RESULTS Histopathological examination of the lung tissue after contusion revealed perivascular/intra-alveolar hemorrhage, perivascular/interstitial leukocyte infiltration, and interstitial/intra-alveolar edema. These histological changes and the extent of lung contusion, as determined by computed tomography, were significantly mitigated by hydrogen inhalation. Hydrogen inhalation also significantly reduced inflammatory cytokine and chemokine mRNA levels and improved oxygenation. CONCLUSION Hydrogen inhalation therapy significantly mitigated inflammatory responses associated with lung contusion in mice. Hydrogen inhalation therapy may be a supplemental therapeutic strategy for treating lung contusion.
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Affiliation(s)
- Kohei Ageta
- Department of Emergency, Critical Care, and Disaster Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences
| | - Takahiro Hirayama
- Department of Emergency, Critical Care, and Disaster Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences
| | - Toshiyuki Aokage
- Department of Emergency, Critical Care, and Disaster Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences
| | - Mizuki Seya
- Department of Emergency, Critical Care, and Disaster Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences
| | - Ying Meng
- Department of Emergency, Critical Care, and Disaster Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences
| | - Tsuyoshi Nojima
- Department of Emergency, Critical Care, and Disaster Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences
| | - Hirotsugu Yamamoto
- Department of Emergency, Critical Care, and Disaster Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences
| | - Takafumi Obara
- Department of Emergency, Critical Care, and Disaster Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences
| | - Atsunori Nakao
- Department of Emergency, Critical Care, and Disaster Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences
| | - Tetsuya Yumoto
- Department of Emergency, Critical Care, and Disaster Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences
| | - Kohei Tsukahara
- Department of Emergency, Critical Care, and Disaster Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences
| | - Hiromichi Naito
- Department of Emergency, Critical Care, and Disaster Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences.
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Naito H, Sakuraya M, Hongo T, Takada H, Yumoto T, Yorifuji T, Hifumi T, Inoue A, Sakamoto T, Kuroda Y, Nakao A. Prevalence, reasons, and timing of decisions to withhold/withdraw life-sustaining therapy for out-of-hospital cardiac arrest patients with extracorporeal cardiopulmonary resuscitation. Crit Care 2023; 27:252. [PMID: 37370155 DOI: 10.1186/s13054-023-04534-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [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: 04/17/2023] [Accepted: 06/19/2023] [Indexed: 06/29/2023] Open
Abstract
BACKGROUND Extracorporeal cardiopulmonary resuscitation (ECPR) is rapidly becoming a common treatment strategy for patients with refractory cardiac arrest. Despite its benefits, ECPR raises a variety of ethical concerns when the treatment is discontinued. There is little information about the decision to withhold/withdraw life-sustaining therapy (WLST) for out-of-hospital cardiac arrest (OHCA) patients after ECPR. METHODS We conducted a secondary analysis of data from the SAVE-J II study, a retrospective, multicenter study of ECPR in Japan. Adult patients who underwent ECPR for OHCA with medical causes were included. The prevalence, reasons, and timing of WLST decisions were recorded. Outcomes of patients with or without WLST decisions were compared. Further, factors associated with WLST decisions were examined. RESULTS We included 1660 patients in the analysis; 510 (30.7%) had WLST decisions. The number of WLST decisions was the highest on the first day and WSLT decisions were made a median of two days after ICU admission. Reasons for WLST were perceived unfavorable neurological prognosis (300/510 [58.8%]), perceived unfavorable cardiac/pulmonary prognosis (105/510 [20.5%]), inability to maintain extracorporeal cardiopulmonary support (71/510 [13.9%]), complications (10/510 [1.9%]), exacerbation of comorbidity before cardiac arrest (7/510 [1.3%]), and others. Patients with WLST had lower 30-day survival (WLST vs. no-WLST: 36/506 [7.1%] vs. 386/1140 [33.8%], p < 0.001). Primary cerebral disorders as cause of cardiac arrest and higher severity of illness at intensive care unit admission were associated with WLST decisions. CONCLUSION For approximately one-third of ECPR/OHCA patients, WLST was decided during admission, mainly because of perceived unfavorable neurological prognoses. Decisions and neurological assessments for ECPR/OHCA patients need further analysis.
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Affiliation(s)
- Hiromichi Naito
- Department of Emergency, Critical Care, and Disaster Medicine, Okayama University Faculty of Medicine, Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, 2-5-1 Shikata, Kita, Okayama, 700-8558, Japan.
| | - Masaaki Sakuraya
- Department of Emergency and Intensive Care Medicine, JA Hiroshima General Hospital, 1-3-3 Jigozen, Hatsukaichi, Hiroshima, 738-0042, Japan
| | - Takashi Hongo
- Department of Emergency, Critical Care, and Disaster Medicine, Okayama University Faculty of Medicine, Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, 2-5-1 Shikata, Kita, Okayama, 700-8558, Japan
| | - Hiroaki Takada
- Department of Critical Care Medicine and Trauma, National Hospital Organization Disaster Medical Center, 3256 Midori, Tachikawa, Tokyo, 190-0014, Japan
| | - Tetsuya Yumoto
- Department of Emergency, Critical Care, and Disaster Medicine, Okayama University Faculty of Medicine, Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, 2-5-1 Shikata, Kita, Okayama, 700-8558, Japan
| | - Takashi Yorifuji
- Department of Epidemiology, Okayama University Faculty of Medicine, Dentistry, and Pharmaceutical Science, 2-5-1 Shikata, Kita, Okayama, 700-8558, Japan
| | - Toru Hifumi
- Department of Emergency and Critical Care Medicine, St. Luke's International Hospital, Akashi, Chuo, Tokyo, 104-8560, Japan
| | - Akihiko Inoue
- Department of Emergency and Critical Care Medicine, Hyogo Emergency Medical Center, 1-3-1 Wakihamakaigandori, Chuo, Kobe, Hyogo, 651-0073, Japan
| | - Tetsuya Sakamoto
- Department of Emergency Medicine, Teikyo University School of Medicine, 2-11-1 Kaga, Itabashi, Tokyo, 173-8606, Japan
| | - Yasuhiro Kuroda
- Department of Emergency, Disaster, and Critical Care Medicine, Faculty of Medicine, Kagawa University, 1750-1 Ikenobe, Miki, Kita, Kagawa, 761-0793, Japan
| | - Atsunori Nakao
- Department of Emergency, Critical Care, and Disaster Medicine, Okayama University Faculty of Medicine, Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, 2-5-1 Shikata, Kita, Okayama, 700-8558, Japan
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18
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Obara T, Yumoto T, Nojima T, Hongo T, Tsukahara K, Matsumoto N, Yorifuji T, Nakao A, Elmer J, Naito H. Association of Prehospital Physician Presence During Pediatric Out-of-Hospital Cardiac Arrest With Neurologic Outcomes. Pediatr Crit Care Med 2023; 24:e244-e252. [PMID: 36749942 DOI: 10.1097/pcc.0000000000003206] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/09/2023]
Abstract
OBJECTIVES To examine the association of prehospital physician presence with neurologic outcomes of pediatric patients with out-of-hospital cardiac arrest (OHCA). DESIGN Retrospective cohort study. SETTING Data from the Japanese Association for Acute Medicine-OHCA Registry. INTERVENTIONS None. PATIENTS Pediatric patients (age 17 yr old or younger) registered in the database between June 2014 and December 2019. MEASUREMENT AND MAIN RESULTS We used logistic regression models with stabilized inverse probability of treatment weighting (IPTW) to estimate the associated treatment effect of a prehospital physician with 1-month neurologically intact survival. Secondary outcomes included in-hospital return of spontaneous circulation (ROSC) and 1-month survival after OHCA. A total of 1,187 patients (276 in the physician presence group and 911 in the physician absence group) were included (median age 3 yr [interquartile range 0-14 yr]; 723 [61%] male). Comparison of the physician presence group, versus the physician absence, showed 1-month favorable neurologic outcomes of 8.3% (23/276) versus 3.6% (33/911). Physician presence was associated with greater odds of 1-month neurologically intact survival after stabilized IPTW adjustment (adjusted odds ratio [aOR] 1.98, 95% CI 1.08-3.66). We also found an association in the secondary outcome between physician presence, opposed to absence, and in-hospital ROSC (aOR 1.48, 95% CI 1.08-2.04). However, we failed to identify an association with 1-month survival (aOR 1.49, 95% CI 0.97-2.88). CONCLUSIONS Among pediatric patients with OHCA, prehospital physician presence, compared with absence, was associated almost two-fold greater odds of 1-month favorable neurologic outcomes.
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Affiliation(s)
- Takafumi Obara
- Department of Emergency, Critical Care, and Disaster Medicine, Faculty of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University, Okayama, Japan
| | - Tetsuya Yumoto
- Department of Emergency, Critical Care, and Disaster Medicine, Faculty of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University, Okayama, Japan
| | - Tsuyoshi Nojima
- Department of Emergency, Critical Care, and Disaster Medicine, Faculty of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University, Okayama, Japan
| | - Takashi Hongo
- Department of Emergency, Critical Care, and Disaster Medicine, Faculty of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University, Okayama, Japan
| | - Kohei Tsukahara
- Department of Emergency, Critical Care, and Disaster Medicine, Faculty of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University, Okayama, Japan
| | - Naomi Matsumoto
- Department of Epidemiology, Faculty of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University, Okayama, Japan
| | - Takashi Yorifuji
- Department of Epidemiology, Faculty of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University, Okayama, Japan
| | - Atsunori Nakao
- Department of Emergency, Critical Care, and Disaster Medicine, Faculty of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University, Okayama, Japan
| | - Jonathan Elmer
- Department of Emergency Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA
- Department of Critical Care Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA
- Department of Neurology, University of Pittsburgh School of Medicine, Pittsburgh, PA
| | - Hiromichi Naito
- Department of Emergency, Critical Care, and Disaster Medicine, Faculty of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University, Okayama, Japan
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19
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Inaba M, Naito H, Yorifuji T, Nakamichi C, Maeyama H, Ishikawa H, Shime N, Uemori S, Ishihara S, Takaoka M, Ohtsuka T, Harada M, Nozaki S, Kohama K, Sakurai R, Sato S, Muramatsu S, Yamashita K, Mayumi T, Aita K, Nakao A. Impact of frailty on long-term mortality in older patients receiving intensive care via the emergency department. Sci Rep 2023; 13:5433. [PMID: 37012346 PMCID: PMC10070345 DOI: 10.1038/s41598-023-32519-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2022] [Accepted: 03/28/2023] [Indexed: 04/05/2023] Open
Abstract
The aim of this study was to evaluate whether frailty was associated with 6-month mortality in older adults who were admitted to the intensive care unit (ICU) with an illness requiring emergency care. The investigation was a prospective, multi-center, observational study conducted among the ICUs of 17 participating hospitals. Patients ≥ 65 years of age who were admitted to the ICU directly from an emergency department visit were assessed to determine their baseline Clinical Frailty Scale (CFS) scores before the illness and were surveyed 6 months after admission. Among 650 patients included in the study, the median age was 79 years old, and overall mortality at 6 months was as low as 21%, ranging from 6.2% in patients with CFS 1 to 42.9% in patients with CFS ≥ 7. When adjusted for potential confounders, CFS score was an independent prognostic factor for mortality (one-point increase in CFS, adjusted risk ratio with 95% confidence interval 1.19 [1.09-1.30]). Quality of life 6 months after admission worsened as baseline CFS score increased. However, there was no association between total hospitalization cost and baseline CFS. CFS is an important predictor of long-term outcomes among critically ill older patients requiring emergent admission.
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Affiliation(s)
- Mototaka Inaba
- Department of Emergency, Critical Care, and Disaster Medicine, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, 2-5-1 Shikata, Okayama, 700-8558, Japan.
| | - Hiromichi Naito
- Department of Emergency, Critical Care, and Disaster Medicine, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, 2-5-1 Shikata, Okayama, 700-8558, Japan.
| | - Takashi Yorifuji
- Department of Epidemiology, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama, Japan
| | - Chikaaki Nakamichi
- Advanced Emergency and Critical Care Center, National Hospital Organization, Nagasaki Medical Center, Omura, Japan
| | - Hiroki Maeyama
- Emergency and Critical Care Center, Tsuyama Chuo Hospital, Tsuyama, Japan
| | - Hideki Ishikawa
- Trauma and Resuscitation Center, Teikyo University Hospital, Tokyo, Japan
| | - Nobuaki Shime
- Department of Emergency and Critical Care Medicine, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Sadayori Uemori
- Department of Emergency, Yodogawa Christian Hospital, Osaka, Japan
| | - Satoshi Ishihara
- Department of Emergency and Critical Care, Hyogo Emergency Medical Center, Kobe, Japan
| | - Makoto Takaoka
- Acute Care Division, Harima-Himeji General Medical Center, Himeji, Japan
| | - Tsuyoshi Ohtsuka
- Emergency Department, National Hospital Organization Yokohama Medical Center, Yokohama, Japan
| | - Masahiro Harada
- Department of Emergency and Critical Care, National Hospital Organization Kumamoto Medical Center, Kumamoto, Japan
| | - Satoshi Nozaki
- Emergency Department, Okayama Saiseikai General Hospital, Okayama, Japan
| | - Keisuke Kohama
- Department of Emergency, Disaster, and Critical Care Medicine, Hyogo College of Medicine, Nishinomiya, Japan
| | - Ryota Sakurai
- Department of Emergency and Critical Care Medicine, Faculty of Medicine, Saga University, Saga, Japan
| | - Shuho Sato
- Emergency Medical Center, Saiseikai Senri Hospital, Suita, Japan
| | - Shun Muramatsu
- Emergency Department, Japanese Red Cross Medical Center, Tokyo, Japan
| | - Kazunori Yamashita
- Acute and Critical Care Center, Nagasaki University Hospital, Nagasaki, Japan
| | - Toshihiko Mayumi
- Department of Emergency Medicine, University of Occupational and Environmental Health Hospital, Kitakyushu, Japan
| | - Kaoruko Aita
- Uehiro Division, Center for Death and Life Studies and Practical Ethics, Graduate School of Humanities and Sociology, University of Tokyo, Tokyo, Japan
| | - Atsunori Nakao
- Department of Emergency, Critical Care, and Disaster Medicine, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, 2-5-1 Shikata, Okayama, 700-8558, Japan
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20
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Yumoto T, Hongo T, Hifumi T, Inoue A, Sakamoto T, Kuroda Y, Yorifuji T, Nakao A, Naito H. Association between prehospital advanced life support by emergency medical services personnel and neurological outcomes among adult out-of-hospital cardiac arrest patients treated with extracorporeal cardiopulmonary resuscitation: A secondary analysis of the SAVE-J II study. J Am Coll Emerg Physicians Open 2023; 4:e12948. [PMID: 37064164 PMCID: PMC10090941 DOI: 10.1002/emp2.12948] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Revised: 03/15/2023] [Accepted: 03/22/2023] [Indexed: 04/18/2023] Open
Abstract
Study Objective Early deployment of extracorporeal cardiopulmonary resuscitation (ECPR) is critical in treating refractory out-of-hospital cardiac arrest (OHCA) patients who are potential candidates for ECPR. The effect of prehospital advanced life support (ALS), including epinephrine administration or advanced airway, compared with no ALS in this setting remains unclear. This study's objective was to determine the association between any prehospital ALS care and outcomes of patients who received ECPR with emergency medical services-treated OHCA. Methods This was a secondary analysis of data from the Study of Advanced Cardiac Life Support for Ventricular Fibrillation with Extracorporeal Circulation in Japan (SAVE-J) II study. Patients were separated into 2 groups-those who received prehospital ALS (ALS group) and those did not receive prehospital ALS (no ALS group). Multiple logistic regression analysis was used to investigate the association between prehospital ALS and favorable neurological outcomes (defined as Cerebral Performance Category scores 1-2) at hospital discharge. Results A total of 1289 patients were included, with 644 patients in the ALS group and 645 patients in the no ALS group. There were fewer favorable neurological outcomes at hospital discharge in the ALS group compared with the no ALS group (10.4 vs 19.8%, p <0.001). A multiple logistic regression analysis revealed that any prehospital ALS care (adjusted odds ratios 0.47; 95% confidence interval 0.34-0.66; p <0.001) was associated with unfavorable neurological outcomes at hospital discharge. Conclusion Prehospital ALS was associated with worse neurological outcomes at hospital discharge in patients treated with ECPR for OHCA. Further prospective studies are required to determine the clinical implications of these findings.
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Affiliation(s)
- Tetsuya Yumoto
- Department of Emergency, Critical Care, and Disaster Medicine, Faculty of Medicine, Dentistry, and Pharmaceutical SciencesOkayama UniversityOkayama Kita‐kuOkayamaJapan
| | - Takashi Hongo
- Department of Emergency, Critical Care, and Disaster Medicine, Faculty of Medicine, Dentistry, and Pharmaceutical SciencesOkayama UniversityOkayama Kita‐kuOkayamaJapan
| | - Toru Hifumi
- Department of Emergency and Critical Care MedicineSt. Luke's International HospitalChuo‐kuTokyoJapan
| | - Akihiko Inoue
- Department of Emergency, Disaster and Critical Care MedicineHyogo Emergency Medical CenterChuo‐kuKobeJapan
| | - Tetsuya Sakamoto
- Department of Emergency MedicineTeikyo University School of MedicineItabashi‐KuTokyoJapan
| | - Yasuhiro Kuroda
- Department of Emergency, Disaster, and Critical Care MedicineKagawa University HospitalMiki‐cho, Kita‐gunKagawaJapan
| | - Takashi Yorifuji
- Department of Epidemiology, Faculty of Medicine, Dentistry, and Pharmaceutical SciencesOkayama UniversityOkayama Kita‐kuOkayamaJapan
| | - Atsunori Nakao
- Department of Emergency, Critical Care, and Disaster Medicine, Faculty of Medicine, Dentistry, and Pharmaceutical SciencesOkayama UniversityOkayama Kita‐kuOkayamaJapan
| | - Hiromichi Naito
- Department of Emergency, Critical Care, and Disaster Medicine, Faculty of Medicine, Dentistry, and Pharmaceutical SciencesOkayama UniversityOkayama Kita‐kuOkayamaJapan
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21
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Nishimura T, Suga M, Ishihara S, Nakayama S, Nakao A, Naito H. Influence of coronavirus disease 2019 case surges on prehospital emergency medical service for patients with trauma in Kobe, Japan. Acute Med Surg 2023; 10:e829. [PMID: 36968647 PMCID: PMC10034623 DOI: 10.1002/ams2.829] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Accepted: 02/08/2023] [Indexed: 03/25/2023] Open
Abstract
Aim In the current era of the coronavirus disease 2019 (COVID‐19) pandemic, the responsiveness of emergency medical service (EMS) transport for patients with internal illness is often delayed. However, the influence of the COVID‐19 pandemic on prehospital transport for patients with trauma has not yet been fully elucidated. This study aims to examine the effect of COVID‐19 case surges on EMS transport for patients with trauma during the COVID‐19 states of emergency in Kobe, Japan. Methods EMS data during the states of emergency were compared with those in the 2019 prepandemic period. The incidence of difficulty securing hospital acceptance (four or more calls to medical institutions and ambulance staying at the scene for 30 min or more) was evaluated as a primary outcome. Secondary outcomes were the time spent at the trauma scene and the number of calls requesting hospital acceptance. The time spent at the trauma scene was stratified by trauma severity. Results The incidence of difficulty securing hospital acceptance increased (1.2% versus 3.2%, P < 0.01). Logistic regression analysis revealed that the duration of the states of emergency was associated with difficulty securing hospital acceptance (odds ratio [OR] 2.08, 95% confidence interval 1.77–2.45; P < 0.01). Although the mean time spent at the trauma scene among the less severe, moderately severe, and severe trauma groups was prolonged, the time for the life‐threatening group did not change. The number of request calls increased during the states of emergency. Conclusion Difficulty securing hospital acceptance increased; however, the time spent at the trauma scene did not significantly change for the life‐threatening group.
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Affiliation(s)
- Takeshi Nishimura
- Department of Emergency and Critical Care MedicineOkayama University Graduate School of Medicine, Dentistry, and Pharmaceutical SciencesOkayamaJapan
- Department of Emergency and Critical Care MedicineHyogo Emergency Medical CenterKobeJapan
| | - Masafumi Suga
- Department of Emergency and Critical Care MedicineOkayama University Graduate School of Medicine, Dentistry, and Pharmaceutical SciencesOkayamaJapan
- Department of Emergency and Critical Care MedicineHyogo Emergency Medical CenterKobeJapan
| | - Satoshi Ishihara
- Department of Emergency and Critical Care MedicineHyogo Emergency Medical CenterKobeJapan
| | - Shinichi Nakayama
- Department of Emergency and Critical Care MedicineHyogo Emergency Medical CenterKobeJapan
| | - Atsunori Nakao
- Department of Emergency and Critical Care MedicineOkayama University Graduate School of Medicine, Dentistry, and Pharmaceutical SciencesOkayamaJapan
| | - Hiromichi Naito
- Department of Emergency and Critical Care MedicineOkayama University Graduate School of Medicine, Dentistry, and Pharmaceutical SciencesOkayamaJapan
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22
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Fujimoto R, Suzuki E, Kashima S, Nakamura K, Naito H, Nakao A, Ito H, Yorifuji T. Heat Exposure Following the Rainy Season Is Associated With an Increased Risk of Cardiovascular Emergency Among the Elderly in Japan. J Am Heart Assoc 2023; 12:e027046. [PMID: 36892062 PMCID: PMC10111512 DOI: 10.1161/jaha.122.027046] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/10/2023]
Abstract
Background Despite the impact of heat exposure caused by global warming, few studies have investigated the hourly effects of heat exposure and the risk of cardiovascular disease (CVD) in the elderly. We examined the associations between short-term heat exposure and the risk of CVD in the elderly in Japan and evaluated possible effect-measure modifications by rainy seasons that occur in East Asia. Methods and Results We conducted a time-stratified case-crossover study. The study included 6527 residents in Okayama City, Japan, aged ≥65 years who were transported to emergency hospitals between 2012 and 2019 for the onset of CVD during and a few months after the rainy seasons. We examined the linear associations between temperature and CVD-related emergency calls for each year and for hourly preceding intervals before the emergency call during the most relevant months. Heat exposure during 1 month after the end of the rainy season was associated with CVD risk; the odds ratio (OR) for a 1° C increase in temperature was 1.34 (95% CI, 1.29-1.40). When we further explored the nonlinear association by using the natural cubic spline model, we found a J-shaped relationship. Exposures 0 to 6 hours before the case event (preceding intervals 0-6 hours) were associated with CVD risk, particularly for the preceding interval 0 to 1 hour (OR, 1.33 [95% CI, 1.28-1.39]). For longer periods, the highest risk was at preceding intervals 0 to 23 hours (OR, 1.40 [95% CI, 1.34-1.46]). Conclusions Elderly individuals may be more susceptible to CVD after heat exposure during the month after the rainy season. As shown by finer temporal resolution analyses, short-term exposure to increasing temperature can trigger CVD onset.
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Affiliation(s)
- Ryohei Fujimoto
- Department of Epidemiology, Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Okayama University Okayama Japan
- Department of Cardiovascular Medicine Tsuyama Chuo Hospital Tsuyama Okayama Japan
| | - Etsuji Suzuki
- Department of Epidemiology, Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Okayama University Okayama Japan
- Department of Epidemiology Harvard T.H. Chan School of Public Health Boston MA USA
| | - Saori Kashima
- Environmental Health Sciences Laboratory, Graduate School of Advanced Science and Engineering Hiroshima University Hiroshima Japan
| | - Kazufumi Nakamura
- Department of Cardiovascular Medicine, Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Okayama University Okayama Japan
| | - Hiromichi Naito
- Department of Emergency, Critical Care and Disaster Medicine, Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences Okayama University Okayama Japan
| | - Atsunori Nakao
- Department of Emergency, Critical Care and Disaster Medicine, Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences Okayama University Okayama Japan
| | - Hiroshi Ito
- Department of Cardiovascular Medicine, Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Okayama University Okayama Japan
| | - Takashi Yorifuji
- Department of Epidemiology, Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Okayama University Okayama Japan
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23
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Obara T, Yumoto T, Aoshima K, Tsukahara K, Naito H, Nakao A. Organ Donation after Extracorporeal Cardiopulmonary Resuscitation and Brain Death. Acta Med Okayama 2023; 77:117-120. [PMID: 36849156 DOI: 10.18926/amo/64372] [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] [Subscribe] [Scholar Register] [Indexed: 03/01/2023]
Abstract
A 38-year-old primipara Japanese woman suffered cardiac arrest due to a pulmonary thromboembolism 1 day after undergoing a cesarean section. Extracorporeal cardiopulmonary resuscitation was initiated and extracorporeal membrane oxygenation support was needed for 24 h. Despite intensive care, the patient was diagnosed with brain death on day 6. With the family's consent, comprehensive end-of-life care including organ donation was discussed based on our hospital's policy. The family decided to donate her organs. Specific training and education are required for emergency physicians to optimize the process of incorporating organ donation into end-of-life care while respecting the patient's and family's wishes.
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Affiliation(s)
- Takafumi Obara
- Department of Emergency, Critical Care, and Disaster Medicine, Okayama University Faculty of Medicine, Dentistry and Pharmaceutical Sciences
| | - Tetsuya Yumoto
- Department of Emergency, Critical Care, and Disaster Medicine, Okayama University Faculty of Medicine, Dentistry and Pharmaceutical Sciences
| | - Kenji Aoshima
- Department of Emergency, Critical Care, and Disaster Medicine, Okayama University Faculty of Medicine, Dentistry and Pharmaceutical Sciences
| | - Kohei Tsukahara
- Department of Emergency, Critical Care, and Disaster Medicine, Okayama University Faculty of Medicine, Dentistry and Pharmaceutical Sciences
| | - Hiromichi Naito
- Department of Emergency, Critical Care, and Disaster Medicine, Okayama University Faculty of Medicine, Dentistry and Pharmaceutical Sciences
| | - Atsunori Nakao
- Department of Emergency, Critical Care, and Disaster Medicine, Okayama University Faculty of Medicine, Dentistry and Pharmaceutical Sciences
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24
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Yamamoto S, Kosaki Y, Uehara T, Naito H, Nakao A. A Seat Belt Injury Causing a Large Breast Hematoma: A Case Report. Cureus 2023; 15:e35440. [PMID: 36994269 PMCID: PMC10041664 DOI: 10.7759/cureus.35440] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/22/2023] [Indexed: 03/31/2023] Open
Abstract
Seat belts with shoulder restraints have decreased the frequency of life-threatening severe chest trauma caused by car accidents. However, the introduction of seat belt legislation has led to an increase in a specific pattern of blunt trauma known as seat belt syndrome, which includes rib, clavicle, spine, and sternum fractures, as well as rupture of hollow pelvic and abdominal viscera, mesenteric tears, and major vessel injuries. The shoulder restraint part of the three-point seat belt commonly rests near or over the female and male breast. A 54-year-old female presented to our emergency department complaining of swelling and pain in her left breast immediately after a traffic accident. The patient had used a seat belt with a shoulder restraint. Bruising was noted along her chest where there had been seat belt contact. Her breast hematoma was most likely caused by breast tissue compression between her rib and the seat belt. Contrast-enhanced computed tomography demonstrated a sizable breast hematoma with active arterial contrast material extravasation, as well as multiple left rib fractures. The patient was conservatively treated with analgesic and anti-inflammatory drugs. Complete resolution was achieved, and her breast returned to its normal appearance. Although endovascular treatment and surgical hemostasis have been proposed for the treatment of breast injuries with active bleeding, conservative treatment such as compression hemostasis may be feasible.
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Affiliation(s)
- Shunki Yamamoto
- Department of Emergency, Critical Care, and Disaster Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, JPN
| | - Yoshinori Kosaki
- Department of Emergency, Critical Care, and Disaster Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, JPN
| | - Takenori Uehara
- Department of Emergency, Critical Care, and Disaster Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, JPN
| | - Hiromichi Naito
- Department of Emergency, Critical Care, and Disaster Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, JPN
| | - Atsunori Nakao
- Department of Emergency, Critical Care, and Disaster Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, JPN
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Yamamoto H, Hongo T, Nojima T, Obara T, Kosaki Y, Ageta K, Tsukahara K, Yumoto T, Nakao A, Naito H. Successfully treated case of severe hypothermia secondary to myxedema coma. Acute Med Surg 2023; 10:e828. [PMID: 36936740 PMCID: PMC10014422 DOI: 10.1002/ams2.828] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2022] [Accepted: 02/08/2023] [Indexed: 03/17/2023] Open
Abstract
Background Myxedema coma is an extremely rare but fatal endocrine emergency that requires urgent recognition and treatment. We describe a case of severe hypothermia that rapidly deteriorated to cardiac arrest that was attributed to myxedema coma. Case Presentation A 52-year-old man without a history of hypothyroidism was transferred to our emergency department due to coma and profound hypothermia. The patient developed cardiac arrest immediately after hospital arrival but return of spontaneous circulation was achieved shortly after resuscitation. The patient was noted to have generalized, nonpitting edema, dry skin, severe respiratory acidosis, hyponatremia, and elevated creatinine kinase, which was indicative of hypothyroidism. Myxedema coma was confirmed by a thyroid profile. The patient was successfully treated with intravenous levothyroxine and glucocorticoid. Conclusion Although myxedema coma is a rare cause of severe hypothermia, emergency physicians should be familiar with its clinical features and management.
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Affiliation(s)
- Hirotsugu Yamamoto
- Department of Emergency, Critical Care, and Disaster Medicine, Faculty of Medicine, Dentistry, and Pharmaceutical SciencesOkayama UniversityOkayamaJapan
| | - Takashi Hongo
- Department of Emergency, Critical Care, and Disaster Medicine, Faculty of Medicine, Dentistry, and Pharmaceutical SciencesOkayama UniversityOkayamaJapan
| | - Tsuyoshi Nojima
- Department of Emergency, Critical Care, and Disaster Medicine, Faculty of Medicine, Dentistry, and Pharmaceutical SciencesOkayama UniversityOkayamaJapan
| | - Takafumi Obara
- Department of Emergency, Critical Care, and Disaster Medicine, Faculty of Medicine, Dentistry, and Pharmaceutical SciencesOkayama UniversityOkayamaJapan
| | - Yoshinori Kosaki
- Department of Emergency, Critical Care, and Disaster Medicine, Faculty of Medicine, Dentistry, and Pharmaceutical SciencesOkayama UniversityOkayamaJapan
| | - Kohei Ageta
- Department of Emergency, Critical Care, and Disaster Medicine, Faculty of Medicine, Dentistry, and Pharmaceutical SciencesOkayama UniversityOkayamaJapan
| | - Kohei Tsukahara
- Department of Emergency, Critical Care, and Disaster Medicine, Faculty of Medicine, Dentistry, and Pharmaceutical SciencesOkayama UniversityOkayamaJapan
| | - Tetsuya Yumoto
- Department of Emergency, Critical Care, and Disaster Medicine, Faculty of Medicine, Dentistry, and Pharmaceutical SciencesOkayama UniversityOkayamaJapan
| | - Atsunori Nakao
- Department of Emergency, Critical Care, and Disaster Medicine, Faculty of Medicine, Dentistry, and Pharmaceutical SciencesOkayama UniversityOkayamaJapan
| | - Hiromichi Naito
- Department of Emergency, Critical Care, and Disaster Medicine, Faculty of Medicine, Dentistry, and Pharmaceutical SciencesOkayama UniversityOkayamaJapan
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Hiraoka T, Obara T, Hongo T, Nojima T, Tsukahara K, Yumoto T, Nakao A. Transcranial doppler ultrasound in a 3-month-old infant with brain death. Pediatr Int 2023; 65:e15587. [PMID: 37615385 DOI: 10.1111/ped.15587] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Revised: 05/26/2023] [Accepted: 05/31/2023] [Indexed: 08/25/2023]
Affiliation(s)
- Tomohiro Hiraoka
- Department of Emergency, Critical Care, and Disaster Medicine, Faculty of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama University, Okayama, Japan
| | - Takafumi Obara
- Department of Emergency, Critical Care, and Disaster Medicine, Faculty of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama University, Okayama, Japan
| | - Takashi Hongo
- Department of Emergency, Critical Care, and Disaster Medicine, Faculty of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama University, Okayama, Japan
| | - Tsuyoshi Nojima
- Department of Emergency, Critical Care, and Disaster Medicine, Faculty of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama University, Okayama, Japan
| | - Kohei Tsukahara
- Department of Emergency, Critical Care, and Disaster Medicine, Faculty of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama University, Okayama, Japan
| | - Tetsuya Yumoto
- Department of Emergency, Critical Care, and Disaster Medicine, Faculty of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama University, Okayama, Japan
| | - Atsunori Nakao
- Department of Emergency, Critical Care, and Disaster Medicine, Faculty of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama University, Okayama, Japan
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27
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Hongo T, Yamamoto S, Nojima T, Naito H, Nakao A, Yumoto T. Automatic emergency calls from smartphone/smartwatch applications in trauma. Acute Med Surg 2023; 10:e875. [PMID: 37492862 PMCID: PMC10363817 DOI: 10.1002/ams2.875] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2023] [Revised: 06/21/2023] [Accepted: 07/01/2023] [Indexed: 07/27/2023] Open
Affiliation(s)
- Takashi Hongo
- Department of Emergency, Critical Care, and Disaster Medicine, Faculty of Medicine, Dentistry, and Pharmaceutical SciencesOkayama UniversityOkayamaJapan
| | - Shunki Yamamoto
- Department of Emergency, Critical Care, and Disaster Medicine, Faculty of Medicine, Dentistry, and Pharmaceutical SciencesOkayama UniversityOkayamaJapan
| | - Tsuyoshi Nojima
- Department of Emergency, Critical Care, and Disaster Medicine, Faculty of Medicine, Dentistry, and Pharmaceutical SciencesOkayama UniversityOkayamaJapan
| | - Hiromichi Naito
- Department of Emergency, Critical Care, and Disaster Medicine, Faculty of Medicine, Dentistry, and Pharmaceutical SciencesOkayama UniversityOkayamaJapan
| | - Atsunori Nakao
- Department of Emergency, Critical Care, and Disaster Medicine, Faculty of Medicine, Dentistry, and Pharmaceutical SciencesOkayama UniversityOkayamaJapan
| | - Tetsuya Yumoto
- Department of Emergency, Critical Care, and Disaster Medicine, Faculty of Medicine, Dentistry, and Pharmaceutical SciencesOkayama UniversityOkayamaJapan
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28
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Yamamoto S, Hongo T, Tamura T, Yumoto T, Naito H, Nakao A. Rare case of intracerebral hemorrhage in anaphylactic shock following administration of intramuscular adrenaline: A case report. Clin Case Rep 2022; 10:e6534. [DOI: 10.1002/ccr3.6534] [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: 06/01/2022] [Revised: 07/22/2022] [Accepted: 10/15/2022] [Indexed: 11/16/2022] Open
Affiliation(s)
- Shunki Yamamoto
- Department of Emergency, Critical Care, and Disaster Medicine Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences Okayama Japan
| | - Takashi Hongo
- Department of Emergency, Critical Care, and Disaster Medicine Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences Okayama Japan
- Emergency Department Okayama Saiseikai General Hospital Okayama Japan
| | - Tomokazu Tamura
- Emergency Department Okayama Saiseikai General Hospital Okayama Japan
| | - Tetsuya Yumoto
- Department of Emergency, Critical Care, and Disaster Medicine Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences Okayama Japan
| | - Hiromichi Naito
- Department of Emergency, Critical Care, and Disaster Medicine Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences Okayama Japan
| | - Atsunori Nakao
- Department of Emergency, Critical Care, and Disaster Medicine Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences Okayama Japan
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29
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Seya M, Aokage T, Nojima T, Nakao A, Naito H. Bile pigments in emergency and critical care medicine. Eur J Med Res 2022; 27:224. [PMID: 36309733 PMCID: PMC9618204 DOI: 10.1186/s40001-022-00863-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2022] [Accepted: 10/20/2022] [Indexed: 12/04/2022] Open
Abstract
Bile pigments, such as bilirubin and biliverdin, are end products of the heme degradation pathway in mammals and are widely known for their cytotoxic effects. However, recent studies have revealed that they exert cytoprotective effects through antioxidative, anti-inflammatory, and immunosuppressive properties. All these mechanisms are indispensable in the treatment of diseases in the field of emergency and critical care medicine, such as coronary ischemia, stroke, encephalomyelitis, acute lung injury/acute respiratory distress syndrome, mesenteric ischemia, and sepsis. While further research is required before the safe application of bile pigments in the clinical setting, their underlying mechanisms shed light on their utilization as therapeutic agents in the field of emergency and critical care medicine. This article aims to summarize the current understanding of bile pigments and re-evaluate their therapeutic potential in the diseases listed above.
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Tanabe R, Nojima T, Yumoto T, Nakao A. Elderly woman with rapid progression of swallowing difficulty. J Am Coll Emerg Physicians Open 2022; 3:e12806. [PMID: 36090005 PMCID: PMC9437876 DOI: 10.1002/emp2.12806] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Accepted: 08/01/2022] [Indexed: 11/16/2022] Open
Affiliation(s)
- Ryo Tanabe
- Department of Emergency Critical Care and Disaster Medicine Okayama University Graduate School of Medicine Dentistry, and Pharmaceutical Sciences Okayama Japan
- Department of Emergency Medicine Kasaoka Daiichi Hospital Kasaoka Okayama Japan
| | - Tsuyoshi Nojima
- Department of Emergency Critical Care and Disaster Medicine Okayama University Graduate School of Medicine Dentistry, and Pharmaceutical Sciences Okayama Japan
| | - Tetsuya Yumoto
- Department of Emergency Critical Care and Disaster Medicine Okayama University Graduate School of Medicine Dentistry, and Pharmaceutical Sciences Okayama Japan
| | - Atsunori Nakao
- Department of Emergency Critical Care and Disaster Medicine Okayama University Graduate School of Medicine Dentistry, and Pharmaceutical Sciences Okayama Japan
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31
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Yabuno S, Yasuhara T, Murai S, Yumoto T, Naito H, Nakao A, Date I. Predictive Factors of Return Home and Return to Work for Intensive Care Unit Survivors after Traumatic Brain Injury with a Follow-up Period of 2 Years. Neurol Med Chir (Tokyo) 2022; 62:465-474. [PMID: 36130904 PMCID: PMC9637400 DOI: 10.2176/jns-nmc.2022-0149] [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: 11/23/2022] Open
Abstract
Intensive care unit (ICU) survivors after traumatic brain injury (TBI) frequently have serious disabilities with subsequent difficulty in reintegration into society. We aimed to investigate outcomes for ICU survivors after moderate to severe TBI (msTBI) and to identify predictive factors of return home (RH) and return to work (RTW). This single-center retrospective cohort study was conducted on all trauma patients admitted to the emergency ICU of our hospital between 2013 and 2017. Of these patients, adult (age ≥ 18 years) msTBI patients with head Abbreviated Injury Scale ≥ 3 were extracted. We performed univariate/multivariate logistic regression analyses to explore the predictive factors of RH and RTW. Among a total of 146 ICU survivors after msTBI, 107 were included (median follow-up period: 26 months). The RH and RTW rates were 78% and 35%, respectively. Multivariate analyses revealed that the predictive factors of RH were age < 65 years (P < 0.001), HR < 76 bpm (P = 0.015), platelet count ≥ 19 × 104/μL (P = 0.0037), D-dimer < 26 μg/mL (P = 0.034), and Glasgow Coma Scale (GCS) score > 8 (P = 0.0015). Similarly, the predictive factors of RTW were age < 65 years (P < 0.001) and GCS score > 8 (P = 0.0039). This study revealed that “age” and “GCS score on admission” affected RH and RTW for ICU survivors after msTBI.
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Affiliation(s)
- Satoru Yabuno
- Department of Neurological Surgery, Okayama University Faculty of Medicine, Dentistry and Pharmaceutical Sciences
| | - Takao Yasuhara
- Department of Neurological Surgery, Okayama University Faculty of Medicine, Dentistry and Pharmaceutical Sciences
| | - Satoshi Murai
- Department of Neurosurgery, National Hospital Organization Iwakuni Clinical Center
| | - Tetsuya Yumoto
- Department of Emergency, Critical Care, and Disaster Medicine, Okayama University Faculty of Medicine, Dentistry and Pharmaceutical Sciences
| | - Hiromichi Naito
- Department of Emergency, Critical Care, and Disaster Medicine, Okayama University Faculty of Medicine, Dentistry and Pharmaceutical Sciences
| | - Atsunori Nakao
- Department of Emergency, Critical Care, and Disaster Medicine, Okayama University Faculty of Medicine, Dentistry and Pharmaceutical Sciences
| | - Isao Date
- Department of Neurological Surgery, Okayama University Faculty of Medicine, Dentistry and Pharmaceutical Sciences
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Abe Y, Nakao A, Arikawa Y, Morace A, Mori T, Lan Z, Wei T, Asano S, Minami T, Kuramitsu Y, Habara H, Shiraga H, Fujioka S, Nakai M, Yogo A. Predictive capability of material screening by fast neutron activation analysis using laser-driven neutron sources. Rev Sci Instrum 2022; 93:093523. [PMID: 36182514 DOI: 10.1063/5.0099217] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Accepted: 08/22/2022] [Indexed: 06/16/2023]
Abstract
Bright, short-pulsed neutron beams from laser-driven neutron sources (LANSs) provide a new perspective on material screening via fast neutron activation analysis (FNAA). FNAA is a nondestructive technique for determining material elemental composition based on nuclear excitation by fast neutron bombardment and subsequent spectral analysis of prompt γ-rays emitted by the active nuclei. Our recent experiments and simulations have shown that activation analysis can be used in practice with modest neutron fluences on the order of 105 n/cm2, which is available with current laser technology. In addition, time-resolved γ-ray measurements combined with picosecond neutron probes from LANSs are effective in mitigating the issue of spectral interference between elements, enabling highly accurate screening of complex samples containing many elements. This paper describes the predictive capability of LANS-based activation analysis based on experimental demonstrations and spectral calculations with Monte Carlo simulations.
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Affiliation(s)
- Y Abe
- Graduate School of Engineering, Osaka University, Osaka 565-0871, Japan
| | - A Nakao
- Institute of Laser Engineering, Osaka University, Osaka 565-0871, Japan
| | - Y Arikawa
- Institute of Laser Engineering, Osaka University, Osaka 565-0871, Japan
| | - A Morace
- Institute of Laser Engineering, Osaka University, Osaka 565-0871, Japan
| | - T Mori
- Institute of Laser Engineering, Osaka University, Osaka 565-0871, Japan
| | - Z Lan
- Institute of Laser Engineering, Osaka University, Osaka 565-0871, Japan
| | - T Wei
- Institute of Laser Engineering, Osaka University, Osaka 565-0871, Japan
| | - S Asano
- Institute of Laser Engineering, Osaka University, Osaka 565-0871, Japan
| | - T Minami
- Graduate School of Engineering, Osaka University, Osaka 565-0871, Japan
| | - Y Kuramitsu
- Graduate School of Engineering, Osaka University, Osaka 565-0871, Japan
| | - H Habara
- Graduate School of Engineering, Osaka University, Osaka 565-0871, Japan
| | - H Shiraga
- Institute of Laser Engineering, Osaka University, Osaka 565-0871, Japan
| | - S Fujioka
- Institute of Laser Engineering, Osaka University, Osaka 565-0871, Japan
| | - M Nakai
- Institute of Laser Engineering, Osaka University, Osaka 565-0871, Japan
| | - A Yogo
- Institute of Laser Engineering, Osaka University, Osaka 565-0871, Japan
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Yamashita K, Hongo T, Nojima T, Yumoto T, Nakao A, Naito H. Hamman's Syndrome Accompanied by Diabetic Ketoacidosis; a Case Report. Arch Acad Emerg Med 2022; 10:e68. [PMID: 36381967 PMCID: PMC9637257 DOI: 10.22037/aaem.v10i1.1709] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Hamman's syndrome is an uncommon clinical entity characterized by an idiopathic spontaneous pneumomediastinum as a result of a sudden increase in intra-alveolar pressure. It can be triggered by repeated vomiting or Kussmaul breathing associated with diabetic ketoacidosis (DKA). Careful attention to this particular condition is needed to avoid under-diagnosis and to provide optimal management. Herein, we report a case of an 18-year-old man complaining of chest discomfort and progressive weight loss, ultimately diagnosed with Hamman's syndrome secondary to DKA. The patient's symptoms disappeared after intravenous fluid and insulin administration, while his pneumomediastinum resolved following conservative treatment. Our report highlights the importance of recognition of the links between pneumomediastinum as a cause of chest pain in patients with DKA.
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Affiliation(s)
- Koya Yamashita
- Department of Emergency, Critical Care, and Disaster Medicine, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama, Japan
| | - Takashi Hongo
- Department of Emergency, Critical Care, and Disaster Medicine, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama, Japan
| | - Tsuyoshi Nojima
- Department of Emergency, Critical Care, and Disaster Medicine, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama, Japan
| | - Tetsuya Yumoto
- Department of Emergency, Critical Care, and Disaster Medicine, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama, Japan. ,Corresponding author: Tetsuya Yumoto; Department of Emergency, Critical Care, and Disaster Medicine, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, 2-5-1 Shikata-cho, Kita-ku, Okayama 700-8588, Japan. Phone: +81-86-235-7426, FAX: +81-86-235-7427, E-mail:
| | - Atsunori Nakao
- Department of Emergency, Critical Care, and Disaster Medicine, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama, Japan
| | - Hiromichi Naito
- Department of Emergency, Critical Care, and Disaster Medicine, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama, Japan
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Hongo T, Yumoto T, Naito H, Fujiwara T, Kondo J, Nozaki S, Nakao A. Frequency, associated factors, and associated outcomes of dysphagia following sepsis. Aust Crit Care 2022:S1036-7314(22)00089-3. [PMID: 35851194 DOI: 10.1016/j.aucc.2022.06.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2020] [Revised: 06/04/2022] [Accepted: 06/08/2022] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Identifying dysphagia as a potential complication of sepsis may improve swallowing function and survival while decreasing hospital length of stay. OBJECTIVES Our goal was to determine the frequency of dysphagia in sepsis survivors on the 7th day after admission, as well as their associated factors and outcomes. METHODS This single-centre, retrospective, observational study analysed data from sepsis survivors admitted to Okayama Saiseikai General Hospital from 2018 to 2019. Participants with sepsis were assigned to one of two study groups based on the presence or absence of dysphagia using the criterion of Functional Oral Intake Scale score <5 on the 7th day after admission. We used multivariate logistic regression to determine factors independently associated with dysphagia on the 7th day after admission. Multivariate logistic regression was also used to determine associations between groups and outcomes, including dysphagia on hospital discharge, direct discharge home (discharge of patients directly to their home), and total dependency (Barthel Index score ≤20) on hospital discharge. RESULTS One hundred one patients met the study inclusion criteria, 55 with dysphagia and 46 without dysphagia. Fasting period (adjusted odds ratio [AOR]: 1.31, 95% confidence interval [CI]: 1.07-1.59) and enteral tube feeding (AOR: 8.56, 95% CI: 1.95-37.5) were independently associated with the presence of dysphagia on the 7th day after admission. Dysphagia on the 7th day after admission was associated with dysphagia on hospital discharge (AOR: 46.0, 95%, CI: 7.90-268.3), a lower chance of direct discharge home (AOR: 0.03, 95% CI: 0.01-0.15), and a higher incidence of total dependency (AOR: 9.30, 95% CI: 2.68-32.2). CONCLUSIONS We found that dysphagia was commonly encountered post sepsis. Fasting period and enteral tube feeding were independently associated with dysphagia on the 7th day after admission. Dysphagia on the 7th day after admission was also associated with dysphagia on hospital discharge, nondirect discharge home, and dependency in activities of daily living at the time of hospital discharge.
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Affiliation(s)
- Takashi Hongo
- Okayama Saiseikai General Hospital, Emergency Department, Japan; Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Department of Emergency, Critical Care, and Disaster Medicine, Japan
| | - Tetsuya Yumoto
- Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Department of Emergency, Critical Care, and Disaster Medicine, Japan
| | - Hiromichi Naito
- Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Department of Emergency, Critical Care, and Disaster Medicine, Japan.
| | | | - Jun Kondo
- Okayama Saiseikai General Hospital, Department of Internal Medicine, Japan
| | - Satoshi Nozaki
- Okayama Saiseikai General Hospital, Emergency Department, Japan
| | - Atsunori Nakao
- Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Department of Emergency, Critical Care, and Disaster Medicine, Japan
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Obara T, Yamamoto H, Aokage T, Igawa T, Nojima T, Hirayama T, Seya M, Ishikawa-Aoyama M, Nakao A, Motterlini R, Naito H. Luminal Administration of a Water-soluble Carbon Monoxide-releasing Molecule (CORM-3) Mitigates Ischemia/Reperfusion Injury in Rats Following Intestinal Transplantation. Transplantation 2022; 106:1365-1375. [PMID: 34966108 PMCID: PMC9213078 DOI: 10.1097/tp.0000000000004007] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2021] [Revised: 10/05/2021] [Accepted: 10/22/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND The protective effects of carbon monoxide (CO) against ischemia/reperfusion (IR) injury during organ transplantation have been extensively investigated. Likewise, CO-releasing molecules (CORMs) are known to exert a variety of pharmacological activities via liberation of controlled amounts of CO in organs. Therefore, we hypothesized that intraluminal administration of water-soluble CORM-3 during cold storage of intestinal grafts would provide protective effects against IR injury. METHODS Orthotopic syngeneic intestinal transplantation was performed in Lewis rats following 6 h of cold preservation in Ringer solution or University of Wisconsin solution. Saline containing CORM-3 (100 µmol/L) or its inactive counterpart (iCORM-3) was intraluminally introduced in the intestinal graft before cold preservation. RESULTS Histopathological analysis of untreated and iCORM-3-treated grafts revealed a similar erosion and blunting of the intestinal villi. These changes in the mucosa structure were significantly attenuated by intraluminal administration of CORM-3. Intestinal mucosa damage caused by IR injury led to considerable deterioration of gut barrier function 3 h postreperfusion. CORM-3 significantly inhibited upregulation of proinflammatory mRNA levels, ameliorated intestinal morphological changes, and improved graft blood flow and mucosal barrier function. Additionally, CORM-3-treated grafts increased recipient survival rates. Pharmacological blockade of soluble guanylyl cyclase activity significantly reversed the protective effects conferred by CORM-3, indicating that CO partially mediates its therapeutic actions via soluble guanylyl cyclase activation. CONCLUSIONS Our study demonstrates that luminally delivered CORM-3 provides beneficial effects in cold-stored rat small intestinal grafts and could be an attractive therapeutic application of CO in the clinical setting of organ preservation and transplantation.
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Affiliation(s)
- Takafumi Obara
- Department of Emergency, Critical Care, and Disaster Medicine, Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University, Okayama, Japan
| | - Hirotsugu Yamamoto
- Department of Emergency, Critical Care, and Disaster Medicine, Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University, Okayama, Japan
| | - Toshiyuki Aokage
- Department of Emergency, Critical Care, and Disaster Medicine, Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University, Okayama, Japan
| | - Takuro Igawa
- Department of Pathology, Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University, Okayama, Japan
| | - Tsuyoshi Nojima
- Department of Emergency, Critical Care, and Disaster Medicine, Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University, Okayama, Japan
| | - Takahiro Hirayama
- Department of Emergency, Critical Care, and Disaster Medicine, Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University, Okayama, Japan
| | - Mizuki Seya
- Department of Emergency, Critical Care, and Disaster Medicine, Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University, Okayama, Japan
| | - Michiko Ishikawa-Aoyama
- Department of Emergency, Disaster and Critical Care Medicine, Hyogo College of Medicine, Nishinomiya, Japan
| | - Atsunori Nakao
- Department of Emergency, Critical Care, and Disaster Medicine, Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University, Okayama, Japan
| | | | - Hiromichi Naito
- Department of Emergency, Critical Care, and Disaster Medicine, Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University, Okayama, Japan
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Tamura N, Obara T, Yamada T, Nojima T, Nakamura S, Koide Y, Takaoka M, Naito H, Nakao A. Adult Scurvy Presenting with Painful Purpura on the Legs. Intern Med 2022; 61:1913-1916. [PMID: 34776490 PMCID: PMC9259809 DOI: 10.2169/internalmedicine.8409-21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Prolonged vitamin C deficiency can result in numerous metabolic abnormalities like impaired tissue repair and defective collagen synthesis. This case report describes a middle-age Japanese man presenting painful purpura on his lower limbs, severe anemia, and altered consciousness. The patient had been eating a selective diet lacking in vegetables and fruits since childhood. A serum analysis demonstrated a low level of vitamin C. The patient was treated with vitamin supplementation and psychological intervention. Scurvy is an under-considered illness with a favorable prognosis if diagnosed early while it is still sporadically encountered in some patients with malabsorption or malnutrition even in modern times.
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Affiliation(s)
- Nayu Tamura
- Center for Graduate Medical Education, Okayama University Hospital, Japan
| | - Takafumi Obara
- Department of Emergency, Critical Care, and Disaster Medicine, Faculty of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University, Japan
| | - Taihei Yamada
- Department of Emergency, Critical Care, and Disaster Medicine, Faculty of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University, Japan
| | - Tsuyoshi Nojima
- Department of Emergency, Critical Care, and Disaster Medicine, Faculty of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University, Japan
| | - Shunsuke Nakamura
- Department of Emergency, Critical Care, and Disaster Medicine, Faculty of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University, Japan
| | - Yasuhiro Koide
- Department of Emergency, Critical Care, and Disaster Medicine, Faculty of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University, Japan
| | - Makoto Takaoka
- Department of Emergency, Steel Memorial Hirohata Hospital, Japan
| | - Hiromichi Naito
- Department of Emergency, Critical Care, and Disaster Medicine, Faculty of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University, Japan
| | - Atsunori Nakao
- Department of Emergency, Critical Care, and Disaster Medicine, Faculty of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University, Japan
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Nojima T, Yumoto T, Naito H, Nakao A. Thoracic vertebral fractures and azygos or hemiazygos vein injuries during cardiopulmonary resuscitation: Caution needed. Resusc Plus 2022; 10:100261. [PMID: 35707219 PMCID: PMC9189869 DOI: 10.1016/j.resplu.2022.100261] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2022] [Accepted: 05/27/2022] [Indexed: 11/29/2022] Open
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Kosaki Y, Naito H, Iida A, Ihoriya H, Nojima T, Yamada T, Yamamoto H, Nakamura S, Mandai Y, Nakao A. The Impact of Medical Students Teaching Basic Life Support to Laypersons. Acta Med Okayama 2022; 76:265-271. [PMID: 35790356 DOI: 10.18926/amo/63720] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Basic life support (BLS) courses for laypersons, including cardiopulmonary resuscitation (CPR) training, is known to improve outcomes of out-of-hospital cardiac events. We asked medical students to provide BLS training for laypersons as a part of their emergency medicine education and evaluated the effects of training on the BLS skills of laypersons. We also used a questionnaire to determine whether the medical students who provided the BLS training were themselves more confident and motivated to perform BLS compared to students who did not provide BLS training. The proportions of laypersons who reported confidence in checking for a response, performing chest compressions, and automated external defibrillator (AED) use were significantly increased after the BLS training. The proportions of medical students who reported increased confidence/motivation in terms of understanding BLS, checking for a response, chest compression, use of AED, and willingness to perform BLS were significantly greater among medical students who provided BLS instructions compared to those who did not. BLS instruction by medical students was associated with an improvement in laypersons' CPR accuracy and confidence in responding to cardiac arrest. The results indicate that medical students could gain understanding, confidence, and motivation in regard to their BLS skills by teaching BLS to laypersons.
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Affiliation(s)
- Yoshinori Kosaki
- Department of Emergency, Critical Care, and Disaster Medicine, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences
| | - Hiromichi Naito
- Department of Emergency, Critical Care, and Disaster Medicine, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences
| | - Atsuyoshi Iida
- Department of Emergency Medicine, Japanese Red Cross Okayama Hospital
| | - Hiromi Ihoriya
- Department of General Medicine, Okayama University Hospital
| | - Tsuyoshi Nojima
- Department of Emergency, Critical Care, and Disaster Medicine, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences
| | - Taihei Yamada
- Department of Emergency, Critical Care, and Disaster Medicine, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences
| | - Hirotsugu Yamamoto
- Department of Emergency, Critical Care, and Disaster Medicine, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences
| | - Shunsuke Nakamura
- Department of Emergency, Critical Care, and Disaster Medicine, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences
| | | | - Atsunori Nakao
- Department of Emergency, Critical Care, and Disaster Medicine, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences
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Nojima T, Naito H, Obara T, Ageta K, Yakushiji H, Yumoto T, Fujisaki N, Nakao A. Can Blood Ammonia Level, Prehospital Time, and Return of Spontaneous Circulation Predict Neurological Outcomes of Out-of-Hospital Cardiac Arrest Patients? A Nationwide, Retrospective Cohort Study. J Clin Med 2022; 11:jcm11092566. [PMID: 35566692 PMCID: PMC9105173 DOI: 10.3390/jcm11092566] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Revised: 04/28/2022] [Accepted: 05/02/2022] [Indexed: 02/06/2023] Open
Abstract
Background: This study aimed to test if blood ammonia levels at hospital arrival, considering prehospital time and the patient’s condition (whether return of spontaneous circulation [ROSC] was achieved at hospital arrival), can predict neurological outcomes after out-of-hospital cardiac arrest (OHCA). Methods: This was a retrospective cohort study on data from a nationwide OHCA registry in Japan. Patients over 17 years old and whose blood ammonia levels had been recorded were included. The primary outcome was favorable neurological outcome at 30 days after OHCA. Blood ammonia levels, prehospital time, and the combination of the two were evaluated using the receiver operating characteristic curve to predict favorable outcomes. Then, cut-off blood ammonia values were determined based on whether ROSC was achieved at hospital arrival. Results: Blood ammonia levels alone were sufficient to predict favorable outcomes. The overall cut-off ammonia value for favorable outcomes was 138 μg/dL; values were different for patients with ROSC (96.5 μg/dL) and those without ROSC (156 μg/dL) at hospital arrival. Conclusions: Our results using patient data from a large OHCA registry showed that blood ammonia levels at hospital arrival can predict neurological outcomes, with different cut-off values for patients with or without ROSC at hospital arrival.
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Affiliation(s)
- Tsuyoshi Nojima
- Department of Emergency, Critical Care and Disaster Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama 700-8558, Japan; (T.N.); (T.O.); (K.A.); (H.Y.); (T.Y.); (N.F.); (A.N.)
- Department of Primary Care and Medical Education, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama 700-8558, Japan
| | - Hiromichi Naito
- Department of Emergency, Critical Care and Disaster Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama 700-8558, Japan; (T.N.); (T.O.); (K.A.); (H.Y.); (T.Y.); (N.F.); (A.N.)
- Correspondence: ; Tel.: +81-86-235-7427
| | - Takafumi Obara
- Department of Emergency, Critical Care and Disaster Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama 700-8558, Japan; (T.N.); (T.O.); (K.A.); (H.Y.); (T.Y.); (N.F.); (A.N.)
| | - Kohei Ageta
- Department of Emergency, Critical Care and Disaster Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama 700-8558, Japan; (T.N.); (T.O.); (K.A.); (H.Y.); (T.Y.); (N.F.); (A.N.)
| | - Hiromasa Yakushiji
- Department of Emergency, Critical Care and Disaster Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama 700-8558, Japan; (T.N.); (T.O.); (K.A.); (H.Y.); (T.Y.); (N.F.); (A.N.)
- Yakushiji Jikei Hospital, Okayama 719-1126, Japan
| | - Tetsuya Yumoto
- Department of Emergency, Critical Care and Disaster Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama 700-8558, Japan; (T.N.); (T.O.); (K.A.); (H.Y.); (T.Y.); (N.F.); (A.N.)
| | - Noritomo Fujisaki
- Department of Emergency, Critical Care and Disaster Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama 700-8558, Japan; (T.N.); (T.O.); (K.A.); (H.Y.); (T.Y.); (N.F.); (A.N.)
| | - Atsunori Nakao
- Department of Emergency, Critical Care and Disaster Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama 700-8558, Japan; (T.N.); (T.O.); (K.A.); (H.Y.); (T.Y.); (N.F.); (A.N.)
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Hongo T, Yamamoto R, Liu K, Yaguchi T, Dote H, Saito R, Masuyama T, Nakatsuka K, Watanabe S, Kanaya T, Yamaguchi T, Yumoto T, Naito H, Nakao A. Association between timing of speech and language therapy initiation and outcomes among post-extubation dysphagia patients: a multicenter retrospective cohort study. Crit Care 2022; 26:98. [PMID: 35395802 PMCID: PMC8991938 DOI: 10.1186/s13054-022-03974-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2021] [Accepted: 03/31/2022] [Indexed: 02/07/2023] Open
Abstract
Background Post-extubation dysphagia (PED) is recognized as a common complication in the intensive care unit (ICU). Speech and language therapy (SLT) can potentially help improve PED; however, the impact of the timing of SLT initiation on persistent PED has not been well investigated. This study aimed to examine the timing of SLT initiation and its effect on patient outcomes after extubation in the ICU. Methods We conducted this multicenter, retrospective, cohort study, collecting data from eight ICUs in Japan. Patients aged ≥ 20 years with orotracheal intubation and mechanical ventilation for longer than 48 h, and those who received SLT due to PED, defined as patients with modified water swallowing test scores of 3 or lower, were included. The primary outcome was dysphagia at hospital discharge, defined as functional oral intake scale score < 5 or death after extubation. Secondary outcomes included dysphagia or death at the seventh, 14th, or 28th day after extubation, aspiration pneumonia, and in-hospital mortality. Associations between the timing of SLT initiation and outcomes were determined using multivariable logistic regression. Results A total of 272 patients were included. Of them, 82 (30.1%) patients exhibited dysphagia or death at hospital discharge, and their time spans from extubation to SLT initiation were 1.0 days. The primary outcome revealed that every day of delay in SLT initiation post-extubation was associated with dysphagia or death at hospital discharge (adjusted odds ratio (AOR), 1.09; 95% CI, 1.02–1.18). Similarly, secondary outcomes showed associations between this per day delay in SLT initiation and dysphagia or death at the seventh day (AOR, 1.28; 95% CI, 1.05–1.55), 14th day (AOR, 1.34; 95% CI, 1.13–1.58), or 28th day (AOR, 1.21; 95% CI, 1.07–1.36) after extubation and occurrence of aspiration pneumonia (AOR, 1.09; 95% CI, 1.02–1.17), while per day delay in post-extubation SLT initiation did not affect in-hospital mortality (AOR, 1.04; 95% CI, 0.97–1.12). Conclusions Delayed initiation of SLT in PED patients was associated with persistent dysphagia or death. Early initiation of SLT may prevent this complication post-extubation. A randomized controlled study is needed to validate these results. Supplementary Information The online version contains supplementary material available at 10.1186/s13054-022-03974-6.
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Affiliation(s)
- Takashi Hongo
- Department of Emergency, Okayama Saiseikai General Hospital, 2-25 Kokutaityo, Okayama Kita-ku, Okayama, 700-8511, Japan.,Department of Emergency, Critical Care, and Disaster Medicine, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, 2-5-1 Shikata-cho, Okayama Kita-ku, Okayama, 700-8558, Japan
| | - Ryohei Yamamoto
- Department of Healthcare Epidemiology, School of Public Health, Graduate School of Medicine, Kyoto University, Yoshida-honmachi, Kyoto Sakyo-ku, Kyoto, 606-8501, Japan
| | - Keibun Liu
- Critical Care Research Group, Faculty of Medicine, University of Queensland, The Prince Charles Hospital, 627 Rode Rd, Chermside, Brisbane, QLD, 4032, Australia
| | - Takahiko Yaguchi
- Department of Intensive Care Medicine, Kameda Medical Center, 929 Higashicho, Kamogawa, Chiba, 296-0041, Japan
| | - Hisashi Dote
- Department of Emergency and Critical Care Medicine, Seirei Hamamatsu General Hospital, 2-12-12 Sumiyoshi, Hamamatsu Naka-ku, Shizuoka, 430-8558, Japan
| | - Ryusuke Saito
- Department of Emergency and Critical Care Medicine, Seirei Hamamatsu General Hospital, 2-12-12 Sumiyoshi, Hamamatsu Naka-ku, Shizuoka, 430-8558, Japan
| | - Tomoyuki Masuyama
- Department of Emergency, Misato Kenwa Hospital, 4-494-1 Takano, Misato, Saitama, 341-0035, Japan
| | - Kosuke Nakatsuka
- Department of Anesthesiology, Okayama Rosai Hospital, 1-10-25 Chikkomidorimachi, Okayama Minami-ku, Okayama, 702-8055, Japan
| | - Shinichi Watanabe
- Department of Rehabilitation, Nagoya Medical Center, NHO, 4-1-1 Sannomaru, , Nagoya Naka-ku, Aichi, 461-0001, Japan
| | - Takahiro Kanaya
- Department of Rehabilitation, Hokkaido Medical Center, NHO, 7-1-1 Yamanote5jo, Sapporo Nishi-ku, Hokkaido, 063-0005, Japan
| | - Tomoya Yamaguchi
- Division of Critical Care Medicine, Nara Prefecture General Medical Center, 2-897-5 Shichijonishimachi, Nara, Nara, 630-8581, Japan
| | - Tetsuya Yumoto
- Department of Emergency, Critical Care, and Disaster Medicine, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, 2-5-1 Shikata-cho, Okayama Kita-ku, Okayama, 700-8558, Japan.
| | - Hiromichi Naito
- Department of Emergency, Critical Care, and Disaster Medicine, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, 2-5-1 Shikata-cho, Okayama Kita-ku, Okayama, 700-8558, Japan
| | - Atsunori Nakao
- Department of Emergency, Critical Care, and Disaster Medicine, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, 2-5-1 Shikata-cho, Okayama Kita-ku, Okayama, 700-8558, Japan
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Nishimura T, Naito H, Nakao A, Nakayama S. Geriatric trauma prognosis trends over 10 years: analysis of a nationwide trauma registry. Trauma Surg Acute Care Open 2022; 7:e000735. [PMID: 35321528 PMCID: PMC8896027 DOI: 10.1136/tsaco-2021-000735] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Accepted: 02/09/2022] [Indexed: 11/05/2022] Open
Abstract
Purpose With Japan’s population rapidly skewing toward aging, the number of geriatric trauma patients is expected to increase. Since we need to continue to improve the quality of geriatric trauma patient care, this study aimed to evaluate in-hospital mortality trends among geriatric trauma patients in Japan over a recent 10-year period. Methods This was a retrospective cohort study of data from a Japanese nationwide trauma registry (the Japan National Trauma Data Bank) on patients admitted between January 1, 2008 and December 31, 2017. Geriatric patients were defined as those 65 years old and older. The primary outcome was to clarify in-hospital mortality trends and changes over these 10 years. Results We identified 265 268 eligible trauma patients. Excluding those under 65 years old and those with inadequate or unknown age data, missing prognosis, out-of-hospital cardiac arrest, and burns, 107 766 patients were enrolled in this study. The total trauma patient in-hospital mortality trend was evaluated using the Cochran-Armitage test and showed a significant decrease (p<0.001). Although severe trauma patients (Injury Severity Score (ISS) ≥16) showed a significant decreasing trend (p<0.001) over time (from 26.1% to 14.5%), less-severe trauma patients (ISS <16) did not (p=0.41) (from 2.7% to 2.1%). Mixed logistic regression analysis showed that the number of year patients stayed in the hospital was significantly associated with mortality. Conclusions While recognizing the limitations of the current analysis, our data demonstrated that prognoses for severe trauma patients over 65 years old improved dramatically over these 10 years, especially in those with severe trauma. Level of evidence Ⅲ—retrospective cohort study.
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Affiliation(s)
- Takeshi Nishimura
- Department of Emergency and Critical Care Medicine, Hyogo Emergency Medical Center, Kobe, Japan.,Department of Emergency and Critical Care Medicine, Okayama University Graduate School of Medicine Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Hiromichi Naito
- Department of Emergency and Critical Care Medicine, Okayama University Graduate School of Medicine Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Atsunori Nakao
- Department of Emergency and Critical Care Medicine, Okayama University Graduate School of Medicine Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Shinichi Nakayama
- Department of Emergency and Critical Care Medicine, Hyogo Emergency Medical Center, Kobe, Japan
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Hongo T, Yumoto T, Naito H, Mikane T, Nakao A. Impact of different medical direction policies on prehospital advanced airway management for out-of hospital cardiac arrest patients: A retrospective cohort study. Resusc Plus 2022; 9:100210. [PMID: 35252900 PMCID: PMC8888968 DOI: 10.1016/j.resplu.2022.100210] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [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: 11/22/2021] [Revised: 12/28/2021] [Accepted: 01/19/2022] [Indexed: 12/26/2022] Open
Abstract
Background Although optimal prehospital airway management after out-of-hospital cardiac arrest (OHCA) remains undetermined, no studies have compared different advanced airway management (AAM) policies adopted by two hospitals in charge of online medical direction by emergency physicians. We examined the impact of two different AAM policies on OHCA patient survival. Methods This observational cohort study included adult OHCA patients treated in Okayama City from 2013 to 2016. Patients were divided into two groups: the O group - those treated on odd days when a hospital with a policy favoring laryngeal tube ventilation (LT) supervised, and the E group - those treated on even days when the other hospital with a policy favoring endotracheal intubation (ETI) supervised. Multiple logistic regression analysis was performed to assess airway device effects. The primary outcome measure was seven-day survival. Results Of 2,406 eligible patients, 50.1% were in the O group and 49.9% were in the E group. O group patients received less ETI (1.0% vs. 12.0%) and more LT (53.3% vs. 43.0%) compared with E group patients. In univariate analysis, no differences were observed in seven-day survival (9.4% vs 10.1%). Multiple regression analysis revealed neither LT nor ETI had a significant independent effect on seven-day survival, considering bag-valve mask ventilation as a reference (OR, 0.78; 95% CI, 0.54 to 1.13, OR, 0.79; 95% CI, 0.36 to 1.72, respectively). Conclusion Despite different advanced airway medical direction policies in a single city, there were no substantial impact on outcomes for OHCA patients.
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Affiliation(s)
- Takashi Hongo
- Department of Emergency, Critical Care, and Disaster Medicine, Okayama University Graduate School of Medicine Dentistry and Pharmaceutical Sciences, Japan
| | - Tetsuya Yumoto
- Department of Emergency, Critical Care, and Disaster Medicine, Okayama University Graduate School of Medicine Dentistry and Pharmaceutical Sciences, Japan
| | - Hiromichi Naito
- Department of Emergency, Critical Care, and Disaster Medicine, Okayama University Graduate School of Medicine Dentistry and Pharmaceutical Sciences, Japan
- Corresponding author at: Okayama University Hospital, Advanced Emergency and Critical Care Medical Center, 2-5-1 Shikata, Okayama 700-8558, Japan.
| | - Takeshi Mikane
- Department of Emergency and Critical Care Medicine, Japanese Red Cross Okayama Hospital, Japan
| | - Atsunori Nakao
- Department of Emergency, Critical Care, and Disaster Medicine, Okayama University Graduate School of Medicine Dentistry and Pharmaceutical Sciences, Japan
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Naito H, Tsukahara K, Takao S, Yorifuji T, Nakao A. Reusable Medical Isolation Gowns with a Liquid Barrier: Washing Gowns in the Coronavirus Disease 2019 Pandemic Era? JMA J 2022; 5:107-108. [PMID: 35224269 PMCID: PMC8827072 DOI: 10.31662/jmaj.2021-0075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Accepted: 10/07/2021] [Indexed: 11/09/2022] Open
Abstract
Healthcare providers are at risk of exposure to SARS-CoV-2 via droplets, respiratory secretions, and contact with contaminated surfaces. Personal protective equipment (PPE) is necessary for primary reliable prevention to treat patients with coronavirus disease 2019 (COVID-19). However, PPE shortages have had a significant impact on every medical facility, and outpatient clinics are especially vulnerable to shortages of medical supplies. During the first stage of the pandemic, efforts were made to reduce the use of medical supplies. Guidance and strategies were proposed to ration the use of PPE, including reusing it. However, reuse (wash) of isolation gowns has not been practically promoted despite these suggestions. Further, reusable products may have advantages for economic and ecologic reasons. We developed an adult universally sized, long-sleeved, 100% polyester, reusable/washable gown with liquid barrier protection. The isolation gown can be worn repeatedly through washing and subsequent disinfection, and it can withstand washing in 80°C hot water for 10 min and/or immersion in 0.05%-0.1% sodium hypochlorite for 30 min and then dried. This new gown’s liquid barrier performance is at Association for the Advancement of Medical Instrumentation level 1, even after 20 repeated uses with low cost. The choice of barrier level for gowns should be made based on the risk of contamination. However, the healthcare setting for COVID-19 patients varies greatly with not fully elucidated transmissibility. The newly made reusable isolation gown can be one option for treating COVID-19 patients especially in low-risk settings with economical advantage. Further, preparedness for reuse may have critical implications in extreme shortage. Reconsideration should be focused on reusable gowns with liquid barrier performance and their appropriate use.
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Affiliation(s)
- Hiromichi Naito
- Department of Emergency, Critical Care, and Disaster Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Kohei Tsukahara
- Department of Emergency, Critical Care, and Disaster Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Soshi Takao
- Department of Epidemiology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Takashi Yorifuji
- Department of Epidemiology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Atsunori Nakao
- Department of Emergency, Critical Care, and Disaster Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
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Nishimura T, Suga M, Nakao A, Ishihara S, Naito H. Prehospital advanced airway management of emergency medical
service‐witnessed
traumatic
out‐of‐hospital
cardiac arrest patients: analysis of
nationwide
trauma registry. Acute Med Surg 2022; 9:e786. [PMID: 36176323 PMCID: PMC9480901 DOI: 10.1002/ams2.786] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Accepted: 08/24/2022] [Indexed: 11/11/2022] Open
Affiliation(s)
- Takeshi Nishimura
- Department of Emergency and Critical Care Medicine Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences Okayama Japan
- Department of Emergency and Critical Care Medicine Hyogo Emergency Medical Center Nishinomiya Japan
| | - Masafumi Suga
- Department of Emergency and Critical Care Medicine Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences Okayama Japan
- Department of Emergency and Critical Care Medicine Hyogo Emergency Medical Center Nishinomiya Japan
| | - Atsunori Nakao
- Department of Emergency and Critical Care Medicine Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences Okayama Japan
| | - Satoshi Ishihara
- Department of Emergency and Critical Care Medicine Hyogo Emergency Medical Center Nishinomiya Japan
| | - Hiromichi Naito
- Department of Emergency and Critical Care Medicine Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences Okayama Japan
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Oda Y, Naito H, Nojima T, Nakao A. Refractory gastric ulcer due to undisclosed use of topical diclofenac epolamine patches. Acute Med Surg 2021; 8:e710. [PMID: 34840802 PMCID: PMC8605476 DOI: 10.1002/ams2.710] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2021] [Revised: 10/26/2021] [Accepted: 10/31/2021] [Indexed: 12/01/2022] Open
Abstract
Background Topical forms of nonsteroidal anti‐inflammatory drugs (NSAIDs) have been created to lessen systemic adverse effects. In general, they are believed to be well tolerated and appropriate for use as an over‐the‐counter (OTC) drug. Case Presentation A 68‐year‐old woman visited our clinic due to tarry stool. The patient reported multiple episodes of recurrent bleeding from a gastric ulcer for 2 months and was treated with endoscopic hemostatic clipping. The patient disclosed she had been using a large number of diclofenac patches for more than 3 months. The patient was treated conservatively by discontinuation of diclofenac patches and treatment with a proton pump inhibitor and omeprazole. Conclusion In conclusion, inappropriate use of topical NSAID patches can be a cause of peptic ulcer bleeding. Patients reporting multiple episodes of recurrent bleeding from a gastric ulcer should be questioned, particularly about the use of OTC medications that might include topical NSAID patches.
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Affiliation(s)
- Yuta Oda
- Dentistry and Pharmaceutical Sciences Department of Emergency Critical Care, and Disaster Medicine Okayama University Graduate School of Medicine Okayama Japan
| | - Hiromichi Naito
- Dentistry and Pharmaceutical Sciences Department of Emergency Critical Care, and Disaster Medicine Okayama University Graduate School of Medicine Okayama Japan
| | - Tsuyoshi Nojima
- Dentistry and Pharmaceutical Sciences Department of Emergency Critical Care, and Disaster Medicine Okayama University Graduate School of Medicine Okayama Japan
| | - Atsunori Nakao
- Dentistry and Pharmaceutical Sciences Department of Emergency Critical Care, and Disaster Medicine Okayama University Graduate School of Medicine Okayama Japan
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Inoguchi K, Hongo T, Naito H, Nakao A. A Rare Case of Pelvic Abscess Due to Spontaneous Non-traumatic Bladder Rupture. Cureus 2021; 13:e18913. [PMID: 34812299 PMCID: PMC8604095 DOI: 10.7759/cureus.18913] [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] [Accepted: 10/19/2021] [Indexed: 11/05/2022] Open
Abstract
Spontaneous bladder rupture is an uncommon and life-threatening urological emergency, and early diagnosis is often challenging. Herein, we report a case of intraperitoneal bladder rupture in an 81-year-old male with neurogenic bladder-the case of intraperitoneal bladder rupture required late laparotomy for pelvic abscess following initial conservative treatment. An eighty-one-year-old male presented to our emergency department with deterioration of consciousness, fever, and hematuria. He denied previous trauma history and had been treated for neurogenic bladder. Physical examination revealed signs of tenderness in the abdomen. A diagnosis of bladder rupture was made based on laboratory examination indicating renal failure and radiological imaging showing urinary ascites. Conservative management with a Foley catheter and antibiotics (meropenem administered 1 g/day) was initiated. On day seven after admission, the patient complained of abdominal pain and fever, and a diagnosis of pelvic abscess based on contrast-enhanced computed tomography and septic peritonitis was made. An emergency exploratory laparotomy for peritoneal drainage was performed. The postoperative course was uneventful, and the patient was discharged on day 29 after admission. Urinary bladder rupture should always be considered as a differential diagnosis in patients presenting with free fluid in the abdomen, peritonitis, reduced urine output, and hematuria. Clinicians should be aware that secondary bacterial peritonitis can occur as a major complication of a ruptured urinary bladder.
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Affiliation(s)
- Kyosuke Inoguchi
- Emergency Department, Okayama Saiseikai General Hospital, Okayama, JPN
| | - Takashi Hongo
- Emergency Department, Okayama Saiseikai General Hospital, Okayama, JPN.,Emergency, Critical Care, and Disaster, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, JPN
| | - Hiromichi Naito
- Emergency, Critical Care, and Disaster, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, JPN
| | - Atsunori Nakao
- Emergency, Critical Care and Disaster, Okayama University Graduate School of Medicine Dentistry and Pharmaceutical Sciences, Okayama, JPN
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Aokage T, Seya M, Hirayama T, Nojima T, Iketani M, Ishikawa M, Terasaki Y, Taniguchi A, Miyahara N, Nakao A, Ohsawa I, Naito H. The effects of inhaling hydrogen gas on macrophage polarization, fibrosis, and lung function in mice with bleomycin-induced lung injury. BMC Pulm Med 2021; 21:339. [PMID: 34719405 PMCID: PMC8559370 DOI: 10.1186/s12890-021-01712-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2021] [Accepted: 10/25/2021] [Indexed: 01/08/2023] Open
Abstract
Background Acute respiratory distress syndrome, which is caused by acute lung injury, is a destructive respiratory disorder caused by a systemic inflammatory response. Persistent inflammation results in irreversible alveolar fibrosis. Because hydrogen gas possesses anti-inflammatory properties, we hypothesized that daily repeated inhalation of hydrogen gas could suppress persistent lung inflammation by inducing functional changes in macrophages, and consequently inhibit lung fibrosis during late-phase lung injury. Methods To test this hypothesis, lung injury was induced in mice by intratracheal administration of bleomycin (1.0 mg/kg). Mice were exposed to control gas (air) or hydrogen (3.2% in air) for 6 h every day for 7 or 21 days. Respiratory physiology, tissue pathology, markers of inflammation, and macrophage phenotypes were examined. Results Mice with bleomycin-induced lung injury that received daily hydrogen therapy for 21 days (BH group) exhibited higher static compliance (0.056 mL/cmH2O, 95% CI 0.047–0.064) than mice with bleomycin-induced lung injury exposed only to air (BA group; 0.042 mL/cmH2O, 95% CI 0.031–0.053, p = 0.02) and lower static elastance (BH 18.8 cmH2O/mL, [95% CI 15.4–22.2] vs. BA 26.7 cmH2O/mL [95% CI 19.6–33.8], p = 0.02). When the mRNA levels of pro-inflammatory cytokines were examined 7 days after bleomycin administration, interleukin (IL)-6, IL-4 and IL-13 were significantly lower in the BH group than in the BA group. There were significantly fewer M2-biased macrophages in the alveolar interstitium of the BH group than in the BA group (3.1% [95% CI 1.6–4.5%] vs. 1.1% [95% CI 0.3–1.8%], p = 0.008). Conclusions The results suggest that hydrogen inhalation inhibits the deterioration of respiratory physiological function and alveolar fibrosis in this model of lung injury. Supplementary Information The online version contains supplementary material available at 10.1186/s12890-021-01712-2.
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Affiliation(s)
- Toshiyuki Aokage
- Department of Emergency, Critical Care and Disaster Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, 2-5-1 Shikata-cho, Kita-ku, Okayama-shi, Okayama, 700-8558, Japan
| | - Mizuki Seya
- Department of Emergency, Critical Care and Disaster Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, 2-5-1 Shikata-cho, Kita-ku, Okayama-shi, Okayama, 700-8558, Japan
| | - Takahiro Hirayama
- Department of Disaster Medicine and Management, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Tsuyoshi Nojima
- Department of Primary Care and Medical Education, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Masumi Iketani
- Department of Biological Process of Aging, Tokyo Metropolitan Institute of Gerontology, Tokyo, Japan
| | - Michiko Ishikawa
- Department of Emergency, Disaster and Critical Care Medicine, Hyogo College of Medicine, Nishinomiya, Japan
| | - Yasuhiro Terasaki
- Department of Analytic Human Pathology, Nippon Medical School, Tokyo, Japan
| | - Akihiko Taniguchi
- Department of Hematology, Oncology, and Respiratory Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Nobuaki Miyahara
- Department of Medical Technology, Okayama University Graduate School of Health Sciences, Okayama, Japan
| | - Atsunori Nakao
- Department of Emergency, Critical Care and Disaster Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, 2-5-1 Shikata-cho, Kita-ku, Okayama-shi, Okayama, 700-8558, Japan
| | - Ikuroh Ohsawa
- Department of Biological Process of Aging, Tokyo Metropolitan Institute of Gerontology, Tokyo, Japan
| | - Hiromichi Naito
- Department of Emergency, Critical Care and Disaster Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, 2-5-1 Shikata-cho, Kita-ku, Okayama-shi, Okayama, 700-8558, Japan.
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Nakamura S, Yamada T, Naito H, Sakoda N, Nakao A. The diagnosis of delayed expanding traumatic pseudoaneurysm of thoracic aorta caused by self-inflicted penetrating injury with crossbow bolt: A case report. Int J Surg Case Rep 2021; 88:106474. [PMID: 34662816 PMCID: PMC8521235 DOI: 10.1016/j.ijscr.2021.106474] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Revised: 09/06/2021] [Accepted: 09/06/2021] [Indexed: 11/28/2022] Open
Abstract
Introduction and importance Penetrating chest trauma caused by a crossbow bolt is very rare. Herein, we report a successfully treated patient who attempted suicide by directing a crossbow to the chest cavity and developed an expanding pseudoaneurysm of the thoracic aorta during eight-day follow up. Case presentation A 51-year-old male was admitted to the emergency department after firing a crossbow bolt twice into his left chest. At admission, the patient was hemodynamically stable and maintaining oxygenation. The bolt had already been removed from the body. Contrast-enhanced computed tomography (CT) revealed a cavity pseudoaneurysm 2.5 mm in size in the aortic arch. Three-dimensional reconstruction of the CT demonstrated wound tracts showing probable damage by the bolt. The patient was admitted to the emergency department for careful observation and transferred to the psychiatric ward on day two. Follow-up contrast-enhanced CT on day eight demonstrated rapid expansion of the pseudoaneurysm from 2.5 mm to 4.0 mm in size. We performed thoracic endovascular aortic repair (TEVAR) on day 13. The patient was uneventfully discharged on the 20th hospital day. Clinical discussion Emergency physicians should be aware that damage to the surrounding tissue may be accompanied by delayed expansion of an aortic pseudoaneurysm, even if the bolts do not cause direct aortic wall injury. Conclusion This case suggests that understanding the injury mechanism, confirming the tract of the bolts, and carefully exploring traumatic pseudoaneurysm can lead to a less invasive operation due to early detection. Crossbow bolts may cause traumatic pseudoaneurysms due to the impact of penetration. A damage to the surrounding tissue may lead to delayed expansion of pseudoaneurysm. Three-dimensional reconstruction of computed tomography images can be useful. Close follow-up for pseudoaneurysm enlargement can avoid mortality and morbidity.
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Affiliation(s)
- Shunsuke Nakamura
- Department of Emergency, Critical Care and Disaster Medicine, Okayama University Graduate School of Medicine Dentistry and Pharmaceutical Sciences, Japan
| | - Taihei Yamada
- Department of Traumatology and Emergency Intensive Care Medicine, Okayama University Graduate School of Medicine Dentistry and Pharmaceutical Sciences, Japan
| | - Hiromichi Naito
- Department of Emergency, Critical Care and Disaster Medicine, Okayama University Graduate School of Medicine Dentistry and Pharmaceutical Sciences, Japan.
| | - Naoya Sakoda
- Department of Cardiovascular Surgery, Okayama University Graduate School of Medicine Dentistry and Pharmaceutical Sciences, Japan
| | - Atsunori Nakao
- Department of Emergency, Critical Care and Disaster Medicine, Okayama University Graduate School of Medicine Dentistry and Pharmaceutical Sciences, Japan
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Naito H, Yumoto T, Yorifuji T, Nojima T, Yamamoto H, Yamada T, Tsukahara K, Inaba M, Nishimura T, Uehara T, Nakao A. Association between emergency medical service transport time and survival in patients with traumatic cardiac arrest: a Nationwide retrospective observational study. BMC Emerg Med 2021; 21:104. [PMID: 34530735 PMCID: PMC8447624 DOI: 10.1186/s12873-021-00499-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2021] [Accepted: 08/28/2021] [Indexed: 12/05/2022] Open
Abstract
Background Patients with traumatic cardiac arrest (TCA) are known to have poor prognoses. In 2003, the joint committee of the National Association of EMS Physicians and the American College of Surgeons Committee on Trauma proposed stopping unsuccessful cardiopulmonary resuscitation (CPR) sustained for > 15 min after TCA. However, in 2013, a specific time-limit for terminating resuscitation was dropped, due to the lack of conclusive studies or data. We aimed to define the association between emergency medical services transport time and survival to demonstrate the survival curve of TCA. Methods A retrospective review of the Japan Trauma Data Bank. Inclusion criteria were age ≥ 16, at least one trauma with Abbreviated Injury Scale score (AIS) ≥ 3, and CPR performed in a prehospital setting. Exclusion criteria were burn injury, AIS score of 6 in any region, and missing data. Estimated survival rate and risk ratio for survival were analyzed according to transport time for all patients. Analysis was also performed separately on patients with sustained TCA at arrival. Results Of 292,027 patients in the database, 5336 were included in the study with 4141 sustained TCA. Their median age was 53 years (interquartile range (IQR) 36–70), and 67.2% were male. Their median Injury Severity Score was 29 (IQR 22–41), and median transport time was 11 min (IQR 6–17). Overall survival after TCA was 4.5%; however, survival of patients with sustained TCA at arrival was only 1.2%. The estimated survival rate and risk ratio for sustained TCA rapidly decreased after 15 min of transport time, with estimated survival falling below 1%. Conclusion The chances of survival for sustained TCA declined rapidly while the patient is transported with CPR support. Time should be one reasonable factor for considering termination of resuscitation in patients with sustained TCA, although clinical signs of life, and type and severity of trauma should be taken into account clinically.
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Affiliation(s)
- Hiromichi Naito
- Department of Emergency, Critical Care, and Disaster Medicine, Dentistry and Pharmaceutical Sciences, Okayama University Graduate School of Medicine, 2-5-1 Shikatacho, Kitaku, Okayama, 700-8558, Japan.
| | - Tetsuya Yumoto
- Department of Emergency, Critical Care, and Disaster Medicine, Dentistry and Pharmaceutical Sciences, Okayama University Graduate School of Medicine, 2-5-1 Shikatacho, Kitaku, Okayama, 700-8558, Japan
| | - Takashi Yorifuji
- Dentistry and Pharmaceutical Sciences, Department of Epidemiology, Okayama University Graduate School of Medicine, Okayama, Japan
| | - Tsuyoshi Nojima
- Department of Emergency, Critical Care, and Disaster Medicine, Dentistry and Pharmaceutical Sciences, Okayama University Graduate School of Medicine, 2-5-1 Shikatacho, Kitaku, Okayama, 700-8558, Japan
| | - Hirotsugu Yamamoto
- Department of Emergency, Critical Care, and Disaster Medicine, Dentistry and Pharmaceutical Sciences, Okayama University Graduate School of Medicine, 2-5-1 Shikatacho, Kitaku, Okayama, 700-8558, Japan
| | - Taihei Yamada
- Department of Emergency, Critical Care, and Disaster Medicine, Dentistry and Pharmaceutical Sciences, Okayama University Graduate School of Medicine, 2-5-1 Shikatacho, Kitaku, Okayama, 700-8558, Japan
| | - Kohei Tsukahara
- Department of Emergency, Critical Care, and Disaster Medicine, Dentistry and Pharmaceutical Sciences, Okayama University Graduate School of Medicine, 2-5-1 Shikatacho, Kitaku, Okayama, 700-8558, Japan
| | - Mototaka Inaba
- Department of Emergency, Critical Care, and Disaster Medicine, Dentistry and Pharmaceutical Sciences, Okayama University Graduate School of Medicine, 2-5-1 Shikatacho, Kitaku, Okayama, 700-8558, Japan
| | - Takeshi Nishimura
- Department of Emergency, Critical Care, and Disaster Medicine, Dentistry and Pharmaceutical Sciences, Okayama University Graduate School of Medicine, 2-5-1 Shikatacho, Kitaku, Okayama, 700-8558, Japan.,Hyogo Emergency Medical Center, Department of Emergency and Critical Care Medicine, Kobe, Hyogo, Japan
| | - Takenori Uehara
- Department of Emergency, Critical Care, and Disaster Medicine, Dentistry and Pharmaceutical Sciences, Okayama University Graduate School of Medicine, 2-5-1 Shikatacho, Kitaku, Okayama, 700-8558, Japan.,Dentistry and Pharmaceutical Sciences, Department of Orthopaedic Surgery, Okayama University Graduate School of Medicine, Okayama, Japan
| | - Atsunori Nakao
- Department of Emergency, Critical Care, and Disaster Medicine, Dentistry and Pharmaceutical Sciences, Okayama University Graduate School of Medicine, 2-5-1 Shikatacho, Kitaku, Okayama, 700-8558, Japan
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Abstract
Acute carbon monoxide (CO) poisoning remains a common cause of poison-related death and influences neurological function. An 83-year-old female was transferred to our emergency unit due to hypertension with dizziness, headache, and right hemiplegia. There was no radiographic evidence of ischemic stroke. The family members reported that the patient may have been exposed to CO by briquettes burned inside a closed room. High flow oxygen therapy was given for suspected CO intoxication and her symptoms quickly improved. Although we do not have clear evidence, we presume that hemiplegia in our patient was caused by CO intoxication, based on rapid recovery with oxygen therapy, carboxyhemoglobin (COHb) level elevation (3.0%), polycythemia, and neuroimaging. Despite the hematogenous effects of CO, paralysis appeared to be more severe on her right side than on her left side. MRI and blood tests helped to support CO as the suspected cause of her hemiplegia. This case reconfirms the importance of medical interviewing by medical practitioners, even in an emergency setting.
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Affiliation(s)
- Kenji Aoshima
- Department of Internal Medicine, Okayama Rōsai Hospital, Okayama, JPN.,Center for Graduate Medical Education, Okayama University Hospital, Okayama, JPN
| | | | - Shunsuke Nakamura
- Department of Emergency, Critical Care and Disaster Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, JPN
| | - Tsuyoshi Nojima
- Department of Emergency, Critical Care and Disaster Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, JPN
| | - Hiromichi Naito
- Department of Emergency, Critical Care and Disaster Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, JPN
| | - Atsunori Nakao
- Department of Emergency, Critical Care and Disaster Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, JPN
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