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Tanaka C, Tagami T, Nakayama F, Kuno M, Kitamura N, Yasunaga H, Aso S, Takeda M, Unemoto K. Changes Over 7 Years in Temperature Control Treatment and Outcomes After Out-of-Hospital Cardiac Arrest: A Japanese, Multicenter Cohort Study. Ther Hypothermia Temp Manag 2024. [PMID: 38386985 DOI: 10.1089/ther.2023.0087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/24/2024] Open
Abstract
Temperature control is the only neuroprotective intervention suggested in current international guidelines for patients with return of spontaneous circulation after cardiac arrest, but the prevalence of temperature control therapy, temperature settings, and outcomes have not been clearly reported. We aimed to investigate changes over 7 years in provision of temperature control treatment among out-of-hospital cardiac arrest (OHCA) patients in Kanto region, Japan. Data of all adult OHCA patients who survived for more than 24 hours in the prospective cohort studies, SOS-KANTO 2012 (conducted from 2012 to 2013) and SOS-KANTO 2017 (conducted from 2019 to 2021), in Japan were included. We compared the prevalence of temperature control and the proportion of mild (≥35°C) and moderate (from 32°C to 34.9°C) hypothermia between the two study groups. We also performed a Cox regression analysis to evaluate 30-day mortality adjusted by temperature control therapy (none, moderate hypothermia, or mild hypothermia), age, sex, past medical history, witnessed status, bystander cardiopulmonary resuscitation, initial rhythm, location of arrest, and dataset (SOS-KANTO 2012 or 2017). We analyzed data from 2936 patients (n = 1710, SOS-KANTO 2012; n = 1226, SOS-KANTO 2017). Use of temperature control was lower (45.3% vs. 41.4%, p = 0.04), moderate hypothermia was lower (p < 0.01), and mild hypothermia was higher (p < 0.01) in SOS-KANTO 2017 compared with SOS-KANTO 2012. The survival rate was significantly higher for patients with mild (p < 0.01) and moderate (p < 0.01) hypothermia compared with those who did not receive temperature control therapy. Overall, the incidence of moderate hypothermia decreased and that of mild hypothermia increased and the use of temperature control decreased between the two studies conducted 7 years apart in the Kanto area, Japan. Temperature control management might improve survival of patients with OHCA.
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Affiliation(s)
- Chie Tanaka
- Department of Emergency and Critical Care Medicine, Nippon Medical School Tama Nagayama Hospital, Tama-shi, Japan
| | - Takashi Tagami
- Department of Emergency and Critical Care Medicine, Nippon Medical School Musashikosugi Hospital, Kawasaki, Japan
- Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, Bunkyo, Japan
| | - Fumihiko Nakayama
- Department of Emergency and Critical Care Medicine, Nippon Medical School Tama Nagayama Hospital, Tama-shi, Japan
| | - Masamune Kuno
- Department of Emergency and Critical Care Medicine, Nippon Medical School Tama Nagayama Hospital, Tama-shi, Japan
| | - Nobuya Kitamura
- Department of Emergency and Critical Care Medicine, Kimitsu Chuo Hospital, Chiba, Japan
| | - Hideo Yasunaga
- Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, Bunkyo, Japan
| | - Shotaro Aso
- Department of Real-World Evidence, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Munekazu Takeda
- Department of Critical Care and Emergency Medicine, Tokyo Women's Medical University, Tokyo, Japan
| | - Kyoko Unemoto
- Department of Emergency and Critical Care Medicine, Nippon Medical School Tama Nagayama Hospital, Tama-shi, Japan
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Tanaka C, Tagami T, Kuno M, Unemoto K. Evaluation of clinical response to empirical antimicrobial therapy on day 7 and mortality in the intensive care unit: sub-analysis of the DIANA study Japanese data. Acute Med Surg 2023; 10:e842. [PMID: 37207117 PMCID: PMC10189631 DOI: 10.1002/ams2.842] [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: 01/26/2023] [Accepted: 04/04/2023] [Indexed: 05/21/2023] Open
Abstract
It is not clear whether evaluating the clinical response to antibiotic use at day 7 among critically ill patients accurately predicts outcomes. We aimed to evaluate the relationship between clinical response to the initial empiric therapy on day 7 and mortality. Methods The determinants of antimicrobial use and de-escalation in critical care (DIANA) study was an international, multicenter, observational study on antibiotic use in the intensive care unit (ICU). ICU patients ages over 18 years in whom an empiric antimicrobial regimen in Japan was initiated were included. We compared patients who were evaluated as cured or improved ("effective") 7 days after starting antibiotic treatment with patients who were evaluated as deteriorated ("failure"). Results Overall, 217 (83%) patients were in the effective group, and 45 (17%) were in the failure group. Both the infection-related mortality rate in the ICU and the in-hospital infection-related mortality rate in the effective group were lower than those in the failure group (0% versus 24.4%; P < 0.01 and 0.5% versus 28.9%; P < 0.01, respectively). Conclusion Assessment of efficacy of empiric antimicrobial treatment on day 7 may predict a favorable outcome among patients suffering from infection in the ICU.
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Affiliation(s)
- Chie Tanaka
- Department of Emergency and Critical Care MedicineNippon Medical School Tama Nagayama HospitalTama‐shiTokyoJapan
| | - Takashi Tagami
- Department of Emergency and Critical Care MedicineNippon Medical School Musashikosugi HospitalKawasakiKanagawaJapan
- Department of Clinical Epidemiology and Health Economics, School of Public HealthSchool of Public HealthThe University of TokyoBunkyoTokyoJapan
| | - Masamune Kuno
- Department of Emergency and Critical Care MedicineNippon Medical School Tama Nagayama HospitalTama‐shiTokyoJapan
| | - Kyoko Unemoto
- Department of Emergency and Critical Care MedicineNippon Medical School Tama Nagayama HospitalTama‐shiTokyoJapan
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3
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Nakamura K, Marushima A, Takahashi Y, Mochizuki M, Kimura A, Fukuda Y, Asami M, Nakamoto H, Egawa S, Kaneko J, Unemoto K, Kondo Y, Yonekawa C, Uchida M, Hoshiyama E, Yamada T, Maruo K, Ishikawa E, Matsumaru Y, Inoue Y. Levetiracetam versus fosphenytoin as a second-line treatment after diazepam for adult convulsive status epilepticus: a multicentre non-inferiority randomised control trial. J Neurol Neurosurg Psychiatry 2023; 94:42-48. [PMID: 36207063 PMCID: PMC9763167 DOI: 10.1136/jnnp-2022-329485] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2022] [Accepted: 08/05/2022] [Indexed: 01/07/2023]
Abstract
OBJECTIVE Status epilepticus (SE) is an emergency condition for which rapid and secured cessation is crucial. Although fosphenytoin (FPHT) is recommended as a second-line treatment, levetiracetam (LEV) reportedly has similar efficacy, but higher safety. Therefore, we herein compared LEV with FPHT in adult SE. METHODS We initiated a multicentre randomised control trial in emergency departments with adult patients with convulsive SE. Diazepam was initially administered, followed intravenously by FPHT at 22.5 mg/kg or LEV at 1000-3000 mg. The primary outcome was assigned as the seizure cessation rate within 30 min of the administration of the study drug. RESULTS A total of 176 adult patients with SE were enrolled (82 FPHT and 94 LEV), and 3 were excluded from the full analysis set. Seizure cessation rates within 30 min were 83.8% (67/80) in the FPHT group and 89.2% (83/93) in the LEV group. The difference in these rates was 5.5% (95% CI -4.7 to 15.7, p=0.29). The non-inferiority of LEV to FPHT was confirmed with p<0.001 by the Farrington-Manning test. No significant differences were observed in the seizure recurrence rate or intubation rate within 24 hours. Serious adverse events developed in three patients in the FPHT group and none in the LEV group (p=0.061). CONCLUSION The efficacy of LEV was similar to that of FPHT for adult SE following the administration of diazepam. LEV may be recommended as a second-line treatment for SE along with phenytoin/FPHT. TRIAL REGISTRATION NUMBER jRCTs031190160.
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Affiliation(s)
- Kensuke Nakamura
- Department of Emergency and Critical Care Medicine, Hitachi General Hospital, Hitachi, Ibaraki, Japan.,Department of Emergency and Critical Care Medicine, University of Tsukuba, Tsukuba, Ibaraki, Japan
| | - Aiki Marushima
- Department of Emergency and Critical Care Medicine, University of Tsukuba, Tsukuba, Ibaraki, Japan .,Division of Stroke prevention and treatment, Department of Neurosurgery, Faculty of Medicine,University of Tsukuba, Tsukuba, Ibaraki, Japan.,Department of Neurosurgery, Faculty of Medicine, University of Tsukuba, Tsukuba, Ibaraki, Japan.,Epilepsy Center, University of Tsukuba Hospital, Tsukuba, Ibaraki, Japan
| | - Yuji Takahashi
- Department of Emergency and Critical Care Medicine, Hitachi General Hospital, Hitachi, Ibaraki, Japan
| | - Masaki Mochizuki
- Department of Emergency and Critical Care Medicine, Hitachi General Hospital, Hitachi, Ibaraki, Japan
| | - Akio Kimura
- Department of Emergency Medicine and Critical Care, National Center for Global Health and Medicine, Toyama Shinjuku, Tokyo, Japan
| | - Yu Fukuda
- Department of Emergency Medicine and Critical Care, National Center for Global Health and Medicine, Toyama Shinjuku, Tokyo, Japan
| | - Masahiro Asami
- Department of Emergency Medicine, Teikyo University Hospital, Itabashi, Tokyo, Japan
| | - Hidetoshi Nakamoto
- Neurointensive Care Unit, Neurosurgery, Stroke and Epilepsy Center, TMG Asaka Medical Center, Asaka, Saitama, Japan
| | - Satoshi Egawa
- Neurointensive Care Unit, Neurosurgery, Stroke and Epilepsy Center, TMG Asaka Medical Center, Asaka, Saitama, Japan
| | - Junya Kaneko
- Department of Emergency and Critical Care Medicine, Nippon Medical School Tama Nagayama Hospital, Tama, Tokyo, Japan
| | - Kyoko Unemoto
- Department of Emergency and Critical Care Medicine, Nippon Medical School Tama Nagayama Hospital, Tama, Tokyo, Japan
| | - Yutaka Kondo
- Department of Emergency and Critical Care Medicine, Juntendo University Urayasu Hospital, Urayasu, Chiba, Japan
| | - Chikara Yonekawa
- Department of Emergency and Critical Care Medicine, Jichi Medical University Hospital, Shimotsuke, Tochigi, Japan
| | - Masatoshi Uchida
- Emergency and Critical Care Medical Center, Dokkyo Medical University, Shimotsuga, Tochigi, Japan
| | - Eisei Hoshiyama
- Emergency and Critical Care Medical Center, Dokkyo Medical University, Shimotsuga, Tochigi, Japan
| | - Takeshi Yamada
- Tsukuba Clinical Research and Development Organization (T-CReDO), University of Tsukuba, Tsukuba, Ibaraki, Japan.,Department of Biostatistics, Faculty of Medicine, University of Tsukuba, Tsukuba, Ibaraki, Japan
| | - Kazushi Maruo
- Department of Biostatistics, Faculty of Medicine, University of Tsukuba, Tsukuba, Ibaraki, Japan
| | - Eiichi Ishikawa
- Department of Neurosurgery, Faculty of Medicine, University of Tsukuba, Tsukuba, Ibaraki, Japan.,Epilepsy Center, University of Tsukuba Hospital, Tsukuba, Ibaraki, Japan
| | - Yuji Matsumaru
- Division of Stroke prevention and treatment, Department of Neurosurgery, Faculty of Medicine,University of Tsukuba, Tsukuba, Ibaraki, Japan.,Department of Neurosurgery, Faculty of Medicine, University of Tsukuba, Tsukuba, Ibaraki, Japan
| | - Yoshiaki Inoue
- Department of Emergency and Critical Care Medicine, University of Tsukuba, Tsukuba, Ibaraki, Japan.,Epilepsy Center, University of Tsukuba Hospital, Tsukuba, Ibaraki, Japan
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Kondo M, Tanaka C, Tagami T, Nagano M, Sugaya K, Tagui N, Kaneko J, Kudo S, Kuno M, Unemoto K, Takase H. Utility of a Compatibility Chart for Continuous Infusions in the Intensive Care Unit. J NIPPON MED SCH 2022; 89:227-232. [PMID: 35545550 DOI: 10.1272/jnms.jnms.2022_89-220] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
BACKGROUND In the intensive care unit (ICU), multiple intravenous drugs are often administered through the same catheter line, greatly increasing the risk of drug incompatibility. We previously developed a compatibility chart including 27 drugs and have used it to avoid drug incompatibilities in the ICU. This retrospective study evaluated the utility of this chart by analyzing prescriptions and incidents of incompatibilities in an ICU. METHODS We analyzed 257 ICU prescriptions of two or more continuous infusions on the same day during the period between March 2016 and February 2017 and investigated the rate of compliance with the compatibility chart. Drug combinations were classified as "compatible," "tolerable compatible," "incompatible," and "no data." For all combinations, the compliance rate was defined as the ratio of compatible and tolerable compatible combinations. Additionally, using our hospital incident report database, we analyzed 27,117 injections administered in the ICU between March 2016 and February 2017 and investigated incidents related to incompatibility. RESULTS Three hundred infusion combinations were identified in the prescriptions. The compliance rate was 97% (n = 293). Of the 113 combinations judged to be tolerable compatible, 98% (n = 111) consisted of three or more continuous medications injected through the same intravenous line. Of the two incidents related to incompatibility in the incident report database, the combination "nicardipine and furosemide" was defined as incompatible in the compatibility chart. CONCLUSIONS The high rate of compliance with the compatibility chart suggested it was useful in preventing drug incompatibility.
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Affiliation(s)
- Masayoshi Kondo
- Department of Pharmacy, Nippon Medical School Tama Nagayama Hospital
| | - Chie Tanaka
- Department of Emergency and Critical Care Medicine, Nippon Medical School Tama Nagayama Hospital
| | - Takashi Tagami
- Department of Emergency and Critical Care Medicine, Nippon Medical School Musashikosugi Hospital
| | - Makihiko Nagano
- Department of Pharmacy, Nippon Medical School Tama Nagayama Hospital
| | - Kazutoshi Sugaya
- Department of Pharmacy, Nippon Medical School Tama Nagayama Hospital
| | - Naoya Tagui
- Department of Pharmacy, Nippon Medical School Tama Nagayama Hospital
| | - Junya Kaneko
- Department of Emergency and Critical Care Medicine, Nippon Medical School Tama Nagayama Hospital
| | - Saori Kudo
- Department of Emergency and Critical Care Medicine, Nippon Medical School Tama Nagayama Hospital
| | - Masamune Kuno
- Department of Emergency and Critical Care Medicine, Nippon Medical School Tama Nagayama Hospital
| | - Kyoko Unemoto
- Department of Emergency and Critical Care Medicine, Nippon Medical School Tama Nagayama Hospital
| | - Hisamitsu Takase
- Department of Pharmacy, Nippon Medical School Tama Nagayama Hospital
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5
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Omoto K, Tanaka C, Fukuda R, Tagami T, Unemoto K. Comparison of the effectiveness of pericardiocentesis and surgical pericardiotomy in the prognosis of patients with blunt traumatic cardiac tamponade: a multicenter study using the Japan Trauma Data Bank. Acute Med Surg 2022; 9:e768. [PMID: 35769387 PMCID: PMC9209333 DOI: 10.1002/ams2.768] [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: 02/08/2022] [Accepted: 05/29/2022] [Indexed: 11/11/2022] Open
Abstract
Aim To compare the prognostic impact of pericardiocentesis (PCC) and surgical pericardiotomy (SP) in blunt traumatic pericardial tamponade. Methods Among 361,706 trauma patients registered in the Japan Trauma Data Bank from January 2004 to December 2018, we included those with blunt traumatic cardiac tamponade who underwent PCC and/or SP. We excluded patients with penetrating trauma, age younger than 15 years, Injury Severity Score (ISS) equal to 75, blood pressure 0 mmHg at the time of admission, head Abbreviated Injury Scale (AIS) score 5 or more, and those with missing data for outcomes. To examine the effect of SP, patients were divided into a PCC group and an SP‐only group. Missing values of age, sex, systolic blood pressure, respiratory rate, pulse rate, time from emergency call to hospital arrival, head AIS, chest AIS, abdomen/pelvis AIS, Glasgow Coma Scale score, and ISS were estimated using multiple imputation. In‐hospital mortality was analyzed using multivariable analysis, and we undertook a survival analysis. Results We analyzed 305 patients, 150 (49.2%) in the PCC group and 155 (50.8%) in the SP‐only group. The in‐hospital mortality rate was 40.7% in the PCC group and 76.8% in the SP‐only group. Multivariable analysis after multiple imputation showed an odds ratio of SP for in‐hospital mortality 5.34 (95% confidence interval, 2.80–10.18; P < 0.01) compared with PCC. Using the Kaplan–Meier method, SP showed a significant risk of mortality (hazard ratio 2.16; 95% confidence interval, 1.58–2.95; P < 0.01). Conclusions In patients with blunt traumatic cardiac tamponade, SP was associated with poor prognosis.
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Affiliation(s)
- Kenichiro Omoto
- Department of Emergency and Critical Care Medicine Nippon Medical School Tama Nagayama Hospital Tokyo Japan
| | - Chie Tanaka
- Department of Emergency and Critical Care Medicine Nippon Medical School Tama Nagayama Hospital Tokyo Japan
| | - Reo Fukuda
- Department of Emergency and Critical Care Medicine Nippon Medical School Tama Nagayama Hospital Tokyo Japan
| | - Takashi Tagami
- Department of Emergency and Critical Care Medicine Nippon Medical School Musashikosugi Hospital Kawasaki Japan
| | - Kyoko Unemoto
- Department of Emergency and Critical Care Medicine Nippon Medical School Tama Nagayama Hospital Tokyo Japan
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6
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Tanaka C, Tagami T, Nakayama F, Kudo S, Takehara A, Fukuda R, Kaneko J, Ishiki Y, Sato S, Shibata A, Kuno M, Unemoto K, Hojo M, Mizoue T, Asai Y, Suzuki S, Ohmagari N. Association between mortality and age among mechanically ventilated COVID-19 patients: a Japanese nationwide COVID-19 database study. Ann Intensive Care 2021; 11:171. [PMID: 34897587 PMCID: PMC8665852 DOI: 10.1186/s13613-021-00959-6] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [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: 08/09/2021] [Accepted: 11/22/2021] [Indexed: 12/15/2022] Open
Abstract
Background Only a few studies have reported the association between age and mortality in COVID-19 patients who require invasive mechanical ventilation (IMV). We aimed to evaluate the effect of age on COVID-19-related mortality among patients undergoing IMV therapy. Methods This cohort study was conducted using the COVID-19 Registry Japan database, a nationwide multi-centre study of hospitalized patients with laboratory-confirmed COVID-19. Of all 33,808 cases registered between 1 January 2020 to 28 February 2021, we analysed 1555 patients who had undergone IMV. We evaluated mortality rates between age groups using multivariable regression analysis after adjusting for known potential components, such as within-hospital clustering, comorbidities, steroid use, medication for COVID-19, and vital signs on admission, using generalized estimation equation. Results By age group, the mortality rates in the IMV group were 8.6%, 20.7%, 34.9%, 49.7% and 83.3% for patients in their 50s, 60s, 70s, 80s, and 90s, respectively. Multivariable analysis showed that compared with those for patients aged < 60 years, the odds ratios (95% confidence interval) of death were 2.6 (1.6–4.1), 6.9 (4.2–11.3), 13.2 (7.2–24.1), 92.6 (16.7–515.0) for patients in their 60s, 70s, 80s, and 90s, respectively. Conclusions In this cohort study, age had a great effect on mortality in COVID-19 patients undergoing IMV, after adjusting for variables independently associated with mortality. This study suggested that age was associated with higher mortality and that preventing progression to severe COVID-19 in elderly patients may be a great public health issue. Supplementary Information The online version contains supplementary material available at 10.1186/s13613-021-00959-6.
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Affiliation(s)
- Chie Tanaka
- Department of Emergency and Critical Care Medicine, Nippon Medical School Tama Nagayama Hospital, Tama-shi, Tokyo, 2068512, Japan
| | - Takashi Tagami
- Department of Emergency and Critical Care Medicine, Nippon Medical School Musashikosugi Hospital, 1-396 Kosugimachi, Nakahara-ku, Kawasaki, Kanagawa, 211-8533, Japan. .,Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, Bunkyo, Tokyo, 1138654, Japan.
| | - Fumihiko Nakayama
- Department of Emergency and Critical Care Medicine, Nippon Medical School Tama Nagayama Hospital, Tama-shi, Tokyo, 2068512, Japan
| | - Saori Kudo
- Department of Emergency and Critical Care Medicine, Nippon Medical School Tama Nagayama Hospital, Tama-shi, Tokyo, 2068512, Japan
| | - Akiko Takehara
- Department of Emergency and Critical Care Medicine, Nippon Medical School Tama Nagayama Hospital, Tama-shi, Tokyo, 2068512, Japan
| | - Reo Fukuda
- Department of Emergency and Critical Care Medicine, Nippon Medical School Tama Nagayama Hospital, Tama-shi, Tokyo, 2068512, Japan
| | - Junya Kaneko
- Department of Emergency and Critical Care Medicine, Nippon Medical School Tama Nagayama Hospital, Tama-shi, Tokyo, 2068512, Japan
| | - Yoshito Ishiki
- Department of Emergency and Critical Care Medicine, Nippon Medical School Tama Nagayama Hospital, Tama-shi, Tokyo, 2068512, Japan
| | - Shin Sato
- Department of Emergency and Critical Care Medicine, Nippon Medical School Tama Nagayama Hospital, Tama-shi, Tokyo, 2068512, Japan
| | - Ami Shibata
- Department of Emergency and Critical Care Medicine, Nippon Medical School Tama Nagayama Hospital, Tama-shi, Tokyo, 2068512, Japan
| | - Masamune Kuno
- Department of Emergency and Critical Care Medicine, Nippon Medical School Tama Nagayama Hospital, Tama-shi, Tokyo, 2068512, Japan
| | - Kyoko Unemoto
- Department of Emergency and Critical Care Medicine, Nippon Medical School Tama Nagayama Hospital, Tama-shi, Tokyo, 2068512, Japan
| | - Masayuki Hojo
- Department of Respiratory Medicine, National Center for Global Health and Medicine, Shinjuku, Tokyo, 1628655, Japan
| | - Tetsuya Mizoue
- Department of Epidemiology and Prevention, Center for Clinical Sciences, National Center for Global Health and Medicine, Shinjuku, Tokyo, 1628655, Japan
| | - Yusuke Asai
- AMR Clinical Reference Center, National Center for Global Health and Medicine, Shinjuku, Tokyo, 1628655, Japan
| | - Setsuko Suzuki
- Disease Control and Prevention Center, National Center for Global Health and Medicine, Shinjuku, Tokyo, 1628655, Japan
| | - Norio Ohmagari
- Disease Control and Prevention Center, National Center for Global Health and Medicine, Shinjuku, Tokyo, 1628655, Japan.,AMR Clinical Reference Center, National Center for Global Health and Medicine, Shinjuku, Tokyo, 1628655, Japan
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Nagano M, Tagami T, Kaneko J, Kondo M, Hotta M, Kubota M, Sugaya K, Takase H, Kuno M, Unemoto K. Blood concentration of levetiracetam after bolus administration in patients with status epilepticus. Seizure 2021; 89:41-44. [PMID: 33984709 DOI: 10.1016/j.seizure.2021.04.017] [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] [Subscribe] [Scholar Register] [Received: 02/06/2021] [Revised: 04/08/2021] [Accepted: 04/21/2021] [Indexed: 11/30/2022] Open
Abstract
PURPOSE We aimed to evaluate the blood concentration of levetiracetam (LEV), as a second-line drug, in patients with status epilepticus (SE) in an emergency clinical setting. METHODS We prospectively evaluated 20 consecutive patients with SE admitted to our department between July 2017 and July 2019. LEV (2500 mg) was administered via bolus infusion after diazepam infusion, followed by 500 mg every 12 h for 48 h and then 500 mg orally. The primary outcomes were LEV blood concentration 15 min, 12 h, 48 h, and 96 h after administration and the proportion of patients showing trough LEV concentration within the therapeutic range. The secondary outcomes were the discontinuation of apparent convulsive seizure, epileptic wave on electroencephalogram, tracheal intubation, adverse events related to blood parameters, and abnormal findings in vital signs examination. RESULTS Median blood LEV (2500 mg) concentration at 15 min after administration was 81.6 μg/mL. The median trough concentration after 12, 48, and 96 h was 28.8, 10.5, and 9.1 μg/mL, respectively. Moreover, 95% of patients had trough concentration above the lower limit of the therapeutic blood concentration (>12 μg/mL) after 12 h. Regarding secondary outcomes, endotracheal intubation, seizure suppression, and abnormal electroencephalogram findings were observed in approximately 40%, 90%-95%, and 41% of patients, respectively. No abnormal findings were noted in blood tests and vital sign examination, although the AST/ALT levels increased in 10% of the patients. CONCLUSION After bolus administration of 2500 mg, the blood LEV concentration reached the therapeutic window in patients with early-stage SE.
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Affiliation(s)
- Makihiko Nagano
- Department of Pharmacy, Nippon Medical School, Tama-Nagayama Hospital, 1-7-1 Nagayama, Tama City, Tokyo 2068512, Japan.
| | - Takashi Tagami
- Department of Emergency and Critical Care Medicine, Nippon Medical School, Musashi-Kosugi Hospital, 1-396 Kosugimachi, Nakahara-ku, Kawasaki-shi, Kanagawa 2118533, Japan
| | - Junya Kaneko
- Department of Emergency and Critical Care Medicine, Nippon Medical School, Tama-Nagayama Hospital, 1-7-1 Nagayama, Tama City, Tokyo 2068512, Japan
| | - Masayoshi Kondo
- Department of Pharmacy, Nippon Medical School, Tama-Nagayama Hospital, 1-7-1 Nagayama, Tama City, Tokyo 2068512, Japan
| | - Mio Hotta
- Akiru Municipal Medical Center, 78-1, Hikida, Akiruno-shi, Tokyo 1970834, Japan
| | - Minoru Kubota
- Department of Clinical Laboratory, Nippon Medical School Hospital, 1-1-5 Sendagi, Bunkyo-ku, Tokyo 1138603, Japan
| | - Kazutoshi Sugaya
- Department of Pharmacy, Nippon Medical School, Tama-Nagayama Hospital, 1-7-1 Nagayama, Tama City, Tokyo 2068512, Japan
| | - Hisamitsu Takase
- Department of Pharmacy, Nippon Medical School, Tama-Nagayama Hospital, 1-7-1 Nagayama, Tama City, Tokyo 2068512, Japan
| | - Masamune Kuno
- Department of Emergency and Critical Care Medicine, Nippon Medical School, Tama-Nagayama Hospital, 1-7-1 Nagayama, Tama City, Tokyo 2068512, Japan
| | - Kyoko Unemoto
- Department of Emergency and Critical Care Medicine, Nippon Medical School, Tama-Nagayama Hospital, 1-7-1 Nagayama, Tama City, Tokyo 2068512, Japan
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8
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Noshiro M, Tagami T, Watanabe A, Hamaguchi A, Nakayama F, Unemoto K, Takenoshita N, Kawamata H, Tajima H, Matsuda K. Elective Endovascular Stent-graft Implantation for External Iliac Artery Injury Following Blunt Pelvic Trauma. J NIPPON MED SCH 2021; 89:342-346. [PMID: 33692306 DOI: 10.1272/jnms.jnms.2022_89-109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
External iliac artery (EIA) injuries caused by blunt trauma are rare. Here, we present the case of a 16-year-old boy who suffered a blunt EIA injury following a motorbike accident. Despite conservative treatment, the intermittent claudication persisted. He was successfully treated using elective endovascular stent-graft implantation on day 59 after the injury. The patient's ankle-brachial index (ABI) improved along with his symptoms. A contrast-enhanced computed tomography scan on postoperative day 90 showed no residual stenosis and favorable peripheral blood flow. This report suggests that elective endovascular stent-graft implantation might be a viable option for the treatment of blunt EIA injuries.
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Affiliation(s)
| | - Takashi Tagami
- Department of Emergency and Critical Care Medicine, Nippon Medical School Musashi Kosugi Hospital
| | - Akihiro Watanabe
- Department of Emergency and Critical Care Medicine, Nippon Medical School Musashi Kosugi Hospital
| | | | - Fumihiko Nakayama
- Department of Emergency and Critical Care Medicine, Nippon Medical School Tamanagayama Hospital
| | - Kyoko Unemoto
- Department of Emergency and Critical Care Medicine, Nippon Medical School Tamanagayama Hospital
| | - Naoko Takenoshita
- Center for Minimally Invasive Treatment, Nippon Medical School Musashi Kosugi Hospital
| | - Hiroshi Kawamata
- Department of Radiology, Nippon Medical School Musashi Kosugi Hospital
| | - Hiroyuki Tajima
- Center for Minimally Invasive Treatment, Nippon Medical School Musashi Kosugi Hospital.,Department of Diagnostic Radiology, Saitama Medical University International Medical Center
| | - Kiyoshi Matsuda
- Department of Emergency and Critical Care Medicine, Nippon Medical School Musashi Kosugi Hospital
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9
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Hifumi T, Yamakawa K, Shiba D, Okazaki T, Kobata H, Gotoh J, Unemoto K, Kondo Y, Yokobori S. Head positioning in suspected patients with acute stroke from prehospital to emergency department settings: a systematic review and meta-analysis. Acute Med Surg 2021; 8:e631. [PMID: 33604055 PMCID: PMC7871203 DOI: 10.1002/ams2.631] [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: 09/23/2020] [Accepted: 01/05/2021] [Indexed: 11/21/2022] Open
Abstract
Aim This study aimed to clarify whether the lying‐flat position from prehospital to emergency department settings more effectively improves neurological outcomes of patients suspected with acute stroke over the sitting‐up position. Methods We searched PubMed, the Cochrane Central Register of Controlled Trials, and Igaku Chuo Zasshi for published randomized controlled trials until September 2019. The study population included patients suspected with acute stroke from prehospital to emergency department settings. We compared outcomes between the lying‐flat position and sitting‐up position groups. The critical outcome was the modified Rankin Scale score at 90 days, and important composite outcomes were 90‐day mortality, pneumonia recurrence, and recurrent ischemic stroke. The certainty of evidence of the outcome level was compared using the Grading of Recommendations Assessment, Development, and Evaluation approach. Results In total, 881 studies were identified from the databases, and two randomized controlled trials were included in the analysis. The pooled risk ratio of 90‐day modified Rankin Scale score was not statistically significant (risk ratio 0.86; 95% confidence interval [CI] 0.56–1.32) between the lying‐flat position and sitting‐up position groups. When comparing the 90‐day mortality, pneumonia occurrence, and recurrent ischemic stroke, no significant differences were observed between the two groups. Risk ratio was 1.00 (95% CI 0.87–1.14), 0.90 (95% CI 0.74–1.11), and 0.81 (95% CI 0.14–4.64) for 90‐day mortality, pneumonia occurrence, and recurrent ischemic stroke, respectively. Conclusion This study suggests that the lying‐flat position is not more effective than the sitting‐up position in terms of 90‐day modified Rankin Scale score in patients suspected with acute stroke.
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Affiliation(s)
- Toru Hifumi
- Department of Emergency and Critical Care Medicine Emergency Medical Center St. Luke's International Hospital Tokyo Japan
| | - Kazuma Yamakawa
- Department of Emergency Medicine Osaka Medical College Takatsuki Japan
| | - Daiki Shiba
- Department of Emergency and Critical Care Medicine Emergency Medical Center St. Luke's International Hospital Tokyo Japan
| | - Tomoya Okazaki
- Emergency Medical Center Kagawa University Hospital Kagawa Japan
| | - Hitoshi Kobata
- Osaka Mishima Emergency Critical Care Center Takatsuki Japan
| | - Jun Gotoh
- Department of Neurology Saiseikai Yokohamashi Tobu Hospital Yokohama Japan
| | - Kyoko Unemoto
- Department of Emergency and Critical Care Medicine Nippon Medical School Tama Nagayama Hospital Tama Japan
| | - Yutaka Kondo
- Department of Emergency and Critical Care Medicine Juntendo University Urayasu Hospital Urayasu Japan
| | - Shoji Yokobori
- Department of Emergency and Critical Care Medicine Nippon Medical School Tokyo Japan
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10
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Kaneko J, Ota T, Unemoto K, Shigeta K, Inoue M, Aoki R, Jimbo H, Ichijo M, Arakawa H, Shiokawa Y, Hirano T. Endovascular treatment of acute basilar artery occlusion: Outcomes, influencing factors and imaging characteristics from the Tama-REgistry of acute thrombectomy (TREAT) study. J Clin Neurosci 2021; 86:184-189. [PMID: 33775325 DOI: 10.1016/j.jocn.2020.12.034] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Revised: 11/06/2020] [Accepted: 12/30/2020] [Indexed: 10/22/2022]
Abstract
OBJECTIVE The effectiveness of mechanical thrombectomy (MT) for acute basilar artery occlusion (ABAO) remains unknown. We evaluated the feasibility, safety, and efficacy of endovascular treatment for ABAO. METHODS We retrospectively investigated patients with ABAO who underwent MT using modern stent retrievers and an aspiration device between January 2015 and March 2019 at 12 comprehensive stroke centers. Functional outcomes and 90-day mortality rates were analyzed as primary outcomes. Factors influencing outcomes were analyzed as secondary outcomes. Relationships between outcome and affected area of infarction on arrival were also analyzed. RESULTS Seventy-three patients were included. Good outcome (modified Rankin Scale (mRS) score 0-2) was achieved in 25/73 patients (34.2%) and the all-cause 90-day mortality rate was 23.3% (17/73). Successful recanalization (modified Thrombolysis In Cerebral Infarction grade 2b and 3) was achieved in 70/73 patients (95.9%). In univariate analyses, age, National Institutes of Health Stroke Scale score, and posterior circulation Alberta Stroke Program Early CT Score (pc-ASPECTS) differed significantly between good and poor functional outcome groups. Age and pc-ASPECTS were significantly associated with functional outcomes in the logistic regression model. Positive findings for the midbrain on diffusion-weighted imaging on pc-ASPECTS and brainstem score were significantly associated with poor outcomes. CONCLUSION MT with modern devices for ABAO resulted in highly successful recanalization and good outcomes. A positive finding for the midbrain on initial imaging might predict poor outcomes. Further studies are required to confirm our results.
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Affiliation(s)
- Junya Kaneko
- Department of Emergency and Critical Care Medicine, Nippon Medical School Tama Nagayama Hospital, Tokyo, Japan.
| | - Takahiro Ota
- Department of Neurosurgery, Tokyo Metropolitan Tama Medical Center, Tokyo, Japan
| | - Kyoko Unemoto
- Department of Emergency and Critical Care Medicine, Nippon Medical School Tama Nagayama Hospital, Tokyo, Japan
| | - Keigo Shigeta
- Department of Neurosurgery, National Hospital Organization Disaster Medical Center, Tokyo, Japan
| | - Masato Inoue
- Department of Neurosurgery, Center Hospital of the National Center for Global Health and Medicine, Tokyo, Japan
| | - Rie Aoki
- Department of Neurosurgery, Tokai University Hachioji Hospital, Tokyo, Japan
| | - Hiroyuki Jimbo
- Department of Neurosurgery, Tokyo Medical University Hachioji Medical Center, Tokyo, Japan
| | - Masahiko Ichijo
- Department of Neurology, Musashino Red Cross Hospital, Tokyo, Japan
| | - Hideki Arakawa
- Department of Neurosurgery, Omori Red Cross Hospital, Tokyo, Japan
| | | | - Teruyuki Hirano
- Department of Stroke and Cerebrovascular Medicine, Kyorin University, Tokyo, Japan
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11
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Yokobori S, Saito K, Sasaki K, Kanaya T, Fujiki Y, Yamaguchi M, Satoh S, Watanabe A, Igarashi Y, Suzuki G, Kaneko J, Nakae R, Onda H, Ishinokami S, Takayama Y, Naoe Y, Sato H, Unemoto K, Fuse A, Yokota H. Treatment of Geriatric Traumatic Brain Injury: A Nationwide Cohort Study. J NIPPON MED SCH 2020; 88:194-203. [PMID: 32612015 DOI: 10.1272/jnms.jnms.2021_88-404] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
BACKGROUND Because of the aging of the Japanese population, traumatic brain injuries (TBI) have increased in elderly adults. However, the effectiveness and prognosis of intensive treatment for geriatric TBI have not yet been determined. Thus, we used nationwide data from the Japan Neurotrauma Data Bank (JNTDB) projects to analyze prognostic factors for intensive and aggressive treatments. METHODS We analyzed 1,879 geriatric TBI cases (age ≥65 years) registered in four JNTDB projects: Project 1998 (P1998) to Project 2015 (P2015). Clinical features, use of aggressive treatment, and 6-month outcomes on the Glasgow Outcome Scale (GOS) were compared among study projects. Logistic regression was used to identify prognostic factors in aggressively treated patients. RESULTS The percentage of geriatric TBI cases significantly increased with time-P1998: 30.1%; Project 2004 (P2004): 34.6%; Project 2009 (P2009): 43.9%; P2015: 53.6%, p<0.0001). Use of aggressive treatment also significantly increased, from 67.0% in P1998 to 69.3% in P2015 (p<0.0001). Less invasive methods, such as trepanation and normothermic targeted temperature management, were more often chosen for geriatric patients. These efforts resulted in a significant decrease in the 6-month mortality rate, from 76.2% in P1998 to 63.1% in P2015 (p=0.0003), although the percentage of severely disabled patients increased, from 8.9% in P1998 to 11.1% in P2015 (p=0.0003). Intraventricular hemorrhage was the factor most strongly associated with unfavorable 6-month outcomes (OR 3.79, 95% CI 1.78-8.06, p<0.0001). CONCLUSIONS Less invasive treatments reduced mortality in geriatric TBI but did not improve functional outcomes. Patient age was not the strongest prognostic factor; thus, physicians should consider characteristics other than age.
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Affiliation(s)
- Shoji Yokobori
- Department of Emergency and Critical Care Medicine, Nippon Medical School
| | - Ken Saito
- Department of Emergency and Critical Care Medicine, Nippon Medical School
| | - Kazuma Sasaki
- Department of Emergency and Critical Care Medicine, Nippon Medical School
| | - Takahiro Kanaya
- Department of Emergency and Critical Care Medicine, Nippon Medical School
| | - Yu Fujiki
- Department of Emergency and Critical Care Medicine, Nippon Medical School
| | - Masahiro Yamaguchi
- Department of Emergency and Critical Care Medicine, Nippon Medical School
| | - Shin Satoh
- Department of Emergency and Critical Care Medicine, Nippon Medical School
| | - Akihiro Watanabe
- Department of Emergency and Critical Care Medicine, Nippon Medical School
| | - Yutaka Igarashi
- Department of Emergency and Critical Care Medicine, Nippon Medical School
| | - Go Suzuki
- Department of Emergency and Critical Care Medicine, Nippon Medical School
| | - Junya Kaneko
- Department of Emergency and Critical Care Medicine, Nippon Medical School
| | - Ryuta Nakae
- Department of Emergency and Critical Care Medicine, Nippon Medical School
| | - Hidetaka Onda
- Department of Emergency and Critical Care Medicine, Nippon Medical School
| | - Saori Ishinokami
- Department of Emergency and Critical Care Medicine, Nippon Medical School
| | - Yasuhiro Takayama
- Department of Emergency and Critical Care Medicine, Nippon Medical School
| | - Yasutaka Naoe
- Department of Emergency and Critical Care Medicine, Nippon Medical School
| | - Hidetaka Sato
- Department of Emergency and Critical Care Medicine, Nippon Medical School
| | - Kyoko Unemoto
- Department of Emergency and Critical Care Medicine, Nippon Medical School
| | - Akira Fuse
- Department of Emergency and Critical Care Medicine, Nippon Medical School
| | - Hiroyuki Yokota
- Department of Emergency and Critical Care Medicine, Nippon Medical School
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12
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Kaneko J, Tagami T, Unemoto K, Tanaka C, Kuwamoto K, Sato S, Tani S, Shibata A, Kudo S, Kitahashi A, Yokota H. Functional Outcome Following Ultra-Early Treatment for Ruptured Aneurysms in Patients with Poor-Grade Subarachnoid Hemorrhage. J NIPPON MED SCH 2019; 86:81-90. [PMID: 31130569 DOI: 10.1272/jnms.jnms.2019_86-203] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
BACKGROUND Little is known regarding functional outcome following poor-grade (World Federation of Neurosurgical Societies grades IV and V) aneurysmal subarachnoid hemorrhage (aSAH), especially in individuals treated aggressively in the early phase after ictus. METHODS We provided patients with aSAH with ultra-early definitive treatment, coiling or clipping, within 6 hours from arrival as per protocol. We classified the patients into 3 groups according to their computed tomography findings: Group 1, intraventricular hemorrhage with obstructive hydrocephalus; Group 2, massive intracerebral hemorrhage with brain herniation; and Group 3, neither Group 1 nor Group 2. We retrospectively evaluated patients with poor-grade aSAH who were admitted to our department between January 2013 and December 2016. We evaluated functional outcome at 6 months, defining modified Rankin Scale (mRS) scores of 0-2 as good and those of 3-6 as poor outcomes. RESULTS A good functional outcome was observed in 39.4% (28/71) of all cases. All-cause mortality at 6 months was 15.5% (11/71). A good outcome in Group 3 was significantly higher than that in the other two groups (Group 1 and 2 vs. Group 3, 20.8% vs. 48.9%, p = 0.02), even after adjustment with a multiple logistic regression analysis (odds ratio 6.1, 95% confidence interval 1.1 to 34.8). CONCLUSIONS Approximately 40% of patients with poor-grade aSAH became functionally independent, and approximately half of the patients with poor-grade aSAH who had neither intraventricular hemorrhage with obstructive hydrocephalus nor with brain herniation had good functional outcomes. Although further trials are required to confirm our results, ultra-early surgery may be considered for patients with poor-grade aSAH.
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Affiliation(s)
- Junya Kaneko
- Department of Emergency and Critical Care Medicine, Nippon Medical School Tama Nagayama Hospital
| | - Takashi Tagami
- Department of Emergency and Critical Care Medicine, Nippon Medical School Tama Nagayama Hospital.,Health Services and Systems Research, Duke-NUS Medical School.,Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo
| | - Kyoko Unemoto
- Department of Emergency and Critical Care Medicine, Nippon Medical School Tama Nagayama Hospital
| | - Chie Tanaka
- Department of Emergency and Critical Care Medicine, Nippon Medical School Tama Nagayama Hospital
| | | | - Shin Sato
- Department of Emergency and Critical Care Medicine, Nippon Medical School Tama Nagayama Hospital
| | - Shosei Tani
- Department of Neurosurgery, Tominaga Hospital
| | - Ami Shibata
- Department of Neurosurgery, Nippon Medical School Chiba Hokusoh Hospital
| | - Saori Kudo
- Department of Emergency and Critical Care Medicine, Nippon Medical School Tama Nagayama Hospital
| | - Akiko Kitahashi
- Department of Emergency and Critical Care Medicine, Nippon Medical School Tama Nagayama Hospital
| | - Hiroyuki Yokota
- Department of Emergency and Critical Care Medicine, Nippon Medical School
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13
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Tanaka C, Tagami T, Kaneko J, Fukuda R, Nakayama F, Sato S, Takehara A, Kudo S, Kuno M, Kondo M, Unemoto K. Early versus late surgery after cervical spinal cord injury: a Japanese nationwide trauma database study. J Orthop Surg Res 2019; 14:302. [PMID: 31488166 PMCID: PMC6729069 DOI: 10.1186/s13018-019-1341-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2019] [Accepted: 08/21/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The management of cervical spinal cord injury (SCI) has changed drastically in the last decades, and surgery is the primary treatment. However, the optimum timing of early surgical treatment (within 24 h or 72 h after injury) is still controversial. We sought to determine the optimum timing of surgery for cervical SCI, comparing the length of the intensive care unit (ICU) stay and in-hospital mortality in patients who underwent surgical treatments (decompression and stabilization) for cervical SCI within 24 h after injury and within 7 days after injury. METHODS This was a retrospective cohort study using Japan Trauma Data Bank (JTDB) which is a nationwide, multicenter database. We selected adult isolated cervical SCI patients who underwent operative management within 7 days after injury, between 2004 and 2015. The main outcome measures were the length of ICU stay and in-hospital mortality. We grouped the patients into two, based on the time from onset of injury to surgery, an early group (within 24 h) and a late group (from 25 h to 7 days). Next, we performed multivariable analyses for analyzing the relevance between the timing of surgery and the length of ICU stay after adjusting for baseline characteristics using propensity score. We also performed the Cox survival analyses to evaluate in-hospital mortality. RESULTS From 236,698 trauma patients registered in JTDB, we analyzed 514 patients. The early group comprised 291 patients (56.6%), and the late group comprised 223 (43.4%). The length of ICU stay did not differ between the two groups (early, 10 days; late, 11 days; p = 0.29). There was no significant difference for length of ICU stay between the early and late group even after adjustment by multivariate analysis (p = 0.64). There was no significant difference in in-hospital mortality between the two groups (the early group 3.8%, the late group 2.2%, p = 0.32), and no significant difference was found in the Cox survival analysis. CONCLUSIONS Our study showed that neither the length of ICU stay nor in-hospital mortality after spinal column stabilization or spinal cord decompression for cervical SCI significantly differed according to the timing of surgery between 24 h and 7 days.
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Affiliation(s)
- Chie Tanaka
- Department of Emergency and Critical Care Medicine, Nippon Medical School Tama Nagayama Hospital, 1-7-1 Nagayama, Tama-shi, Tokyo, 2068512 Japan
| | - Takashi Tagami
- Department of Emergency and Critical Care Medicine, Nippon Medical School Tama Nagayama Hospital, 1-7-1 Nagayama, Tama-shi, Tokyo, 2068512 Japan
- Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 1130033 Japan
| | - Junya Kaneko
- Department of Emergency and Critical Care Medicine, Nippon Medical School Tama Nagayama Hospital, 1-7-1 Nagayama, Tama-shi, Tokyo, 2068512 Japan
| | - Reo Fukuda
- Department of Emergency and Critical Care Medicine, Nippon Medical School Tama Nagayama Hospital, 1-7-1 Nagayama, Tama-shi, Tokyo, 2068512 Japan
| | - Fumihiko Nakayama
- Department of Emergency and Critical Care Medicine, Nippon Medical School Tama Nagayama Hospital, 1-7-1 Nagayama, Tama-shi, Tokyo, 2068512 Japan
| | - Shin Sato
- Department of Emergency and Critical Care Medicine, Nippon Medical School Tama Nagayama Hospital, 1-7-1 Nagayama, Tama-shi, Tokyo, 2068512 Japan
| | - Akiko Takehara
- Department of Emergency and Critical Care Medicine, Nippon Medical School Tama Nagayama Hospital, 1-7-1 Nagayama, Tama-shi, Tokyo, 2068512 Japan
| | - Saori Kudo
- Department of Emergency and Critical Care Medicine, Nippon Medical School Tama Nagayama Hospital, 1-7-1 Nagayama, Tama-shi, Tokyo, 2068512 Japan
| | - Masamune Kuno
- Department of Emergency and Critical Care Medicine, Nippon Medical School Tama Nagayama Hospital, 1-7-1 Nagayama, Tama-shi, Tokyo, 2068512 Japan
| | - Masayoshi Kondo
- Department of Emergency and Critical Care Medicine, Nippon Medical School Tama Nagayama Hospital, 1-7-1 Nagayama, Tama-shi, Tokyo, 2068512 Japan
| | - Kyoko Unemoto
- Department of Emergency and Critical Care Medicine, Nippon Medical School Tama Nagayama Hospital, 1-7-1 Nagayama, Tama-shi, Tokyo, 2068512 Japan
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14
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Tanaka C, Tagami T, Unemoto K, Kudo S, Takehara A, Kaneko J, Yokota H. Intracranial pressure management and neurological outcome for patients with mild traumatic brain injury who required neurosurgical intervention: a Japanese database study. Brain Inj 2019; 33:869-874. [PMID: 31084363 DOI: 10.1080/02699052.2019.1614667] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Purpose: Among mild traumatic brain injuries (mTBI; a Glasgow Coma Scale score ≥13 on arrival), few result in severe neurological deficit, especially when they needed neurosurgical intervention. We investigated the association of intracranial pressure (ICP) control management with neurological outcome in patients with mTBI who needed neurosurgical intervention. Methods: From 1,092 records of the Japan Neurotrauma Data Bank during 2009-2011, we retrospectively identified 195 patients with neurosurgical intervention for mTBI. Using the Glasgow Outcome Scale, we grouped records into two: favorable and poor outcome. We analyzed neurological outcomes using a logistic regression analysis adjusted for ICP control managements. Results: Seventy patients had a poor outcome. Logistic regression analysis revealed that sedatives, hyperosmotic agents, and hyperventilation therapy were significantly associated with poor outcome (odds ratio [OR]: 2.36, 95% confidence interval [CI]: 1.31-4.26; OR: 2.81, 95% CI: 1.17-6.75; OR: 9.36, 95% CI: 1.81-48.35). However, temperature management was significantly related with favorable outcome (OR: 0.26, 95% CI: 0.10-0.66). Conclusions: Our study, using a Japanese multicenter brain trauma registry, suggested that requirement of sedatives, hyperosmotic agents, and hyperventilation is associated with poor neurological outcome for patients with mTBI who underwent neurosurgical intervention, although temperature management was associated with favorable neurological outcome.
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Affiliation(s)
- Chie Tanaka
- a Department of Emergency and Critical Care Medicine , Nippon Medical School Tama Nagayama Hospital , Tokyo , Japan
| | - Takashi Tagami
- a Department of Emergency and Critical Care Medicine , Nippon Medical School Tama Nagayama Hospital , Tokyo , Japan.,b Department of Clinical Epidemiology and Health Economics, School of Public Health , The University of Tokyo , Tokyo , Japan
| | - Kyoko Unemoto
- a Department of Emergency and Critical Care Medicine , Nippon Medical School Tama Nagayama Hospital , Tokyo , Japan
| | - Saori Kudo
- a Department of Emergency and Critical Care Medicine , Nippon Medical School Tama Nagayama Hospital , Tokyo , Japan
| | - Akiko Takehara
- a Department of Emergency and Critical Care Medicine , Nippon Medical School Tama Nagayama Hospital , Tokyo , Japan
| | - Junya Kaneko
- a Department of Emergency and Critical Care Medicine , Nippon Medical School Tama Nagayama Hospital , Tokyo , Japan
| | - Hiroyuki Yokota
- c Department of Emergency and Critical Care Medicine , Nippon Medical School , Tokyo , Japan
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15
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Ishikawa Y, Tagami T, Hirashima H, Fukuda R, Moroe Y, Unemoto K. Endoscopic Treatment of Boerhaave Syndrome Using Polyglycolic Acid Sheets and Fibrin Glue: A Report of Two Cases. J NIPPON MED SCH 2018; 84:241-245. [PMID: 29142186 DOI: 10.1272/jnms.84.241] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Boerhaave syndrome, the spontaneous perforation of the esophagus, is an emergency, life-threatening condition. Current endoscopic treatment options include clipping and stenting, but the use of polyglycolic acid (PGA) sheets for treating the condition has not been reported. In recent years, PGA sheets have been used after endoscopic submucosal dissection to prevent perforations and stricture formation in patients treated for early-stage carcinoma. We report the cases of two patients with Boerhaave syndrome who were successfully treated using PGA sheets. The present clinical outcomes suggest that the use of PGA sheets is feasible and safe for treating patients with Boerhaave syndrome, and that they may be another treatment option.
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Affiliation(s)
- Yumiko Ishikawa
- Department of Emergency and Critical Care Medicine, Nippon Medical School Tama Nagayama Hospital
| | - Takashi Tagami
- Department of Emergency and Critical Care Medicine, Nippon Medical School Tama Nagayama Hospital
| | | | - Reo Fukuda
- Department of Emergency and Critical Care Medicine, Nippon Medical School Tama Nagayama Hospital
| | - Yuuta Moroe
- Department of Emergency and Critical Care Medicine, Nippon Medical School Tama Nagayama Hospital
| | - Kyoko Unemoto
- Department of Emergency and Critical Care Medicine, Nippon Medical School Tama Nagayama Hospital
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16
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Tanaka C, Tagami T, Matsumoto H, Matsuda K, Kim S, Moroe Y, Fukuda R, Unemoto K, Yokota H. Recent trends in 30-day mortality in patients with blunt splenic injury: A nationwide trauma database study in Japan. PLoS One 2017; 12:e0184690. [PMID: 28910356 PMCID: PMC5599007 DOI: 10.1371/journal.pone.0184690] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2017] [Accepted: 08/29/2017] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Splenic injury frequently occurs after blunt abdominal trauma; however, limited epidemiological data regarding mortality are available. We aimed to investigate mortality rate trends after blunt splenic injury in Japan. METHODS We retrospectively identified 1,721 adults with blunt splenic injury (American Association for the Surgery of Trauma splenic injury scale grades III-V) from the 2004-2014 Japan Trauma Data Bank. We grouped the records of these patients into 3 time phases: phase I (2004-2008), phase II (2009-2012), and phase III (2013-2014). Over the 3 phases, we analysed 30-day mortality rates and investigated their association with the prevalence of certain initial interventions (Mantel-Haenszel trend test). We further performed multiple imputation and multivariable analyses for comparing the characteristics and outcomes of patients who underwent TAE or splenectomy/splenorrhaphy, adjusting for known potential confounders and for within-hospital clustering using generalised estimating equation. RESULTS Over time, there was a significant decrease in 30-day mortality after splenic injury (p < 0.01). Logistic regression analysis revealed that mortality significantly decreased over time (from phase I to phase II, odds ratio: 0.39, 95% confidence interval: 0.22-0.67; from phase I to phase III, odds ratio: 0.34, 95% confidence interval: 0.19-0.62) for the overall cohort. While the 30-day mortality for splenectomy/splenorrhaphy diminished significantly over time (p = 0.01), there were no significant differences regarding mortality for non-operative management, with or without transcatheter arterial embolisation (p = 0.43, p = 0.29, respectively). CONCLUSIONS In Japan, in-hospital 30-day mortality rates decreased significantly after splenic injury between 2004 and 2014, even after adjustment for within-hospital clustering and other factors independently associated with mortality. Over time, mortality rates decreased significantly after splenectomy/splenorrhaphy, but not after non-operative management. This information is useful for clinicians when making decisions about treatments for patients with blunt splenic injury.
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Affiliation(s)
- Chie Tanaka
- Department of Emergency and Critical Care Medicine, Nippon Medical School Tama Nagayama Hospital, Tokyo, Japan
| | - Takashi Tagami
- Department of Emergency and Critical Care Medicine, Nippon Medical School Tama Nagayama Hospital, Tokyo, Japan
- Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, Tokyo, Japan
- * E-mail:
| | - Hisashi Matsumoto
- Department of Emergency and Critical Care Medicine, Nippon Medical School Chiba Hokusoh Hospital, Chiba, Japan
| | - Kiyoshi Matsuda
- Department of Emergency and Critical Care Medicine, Nippon Medical School Musashikosugi Hospital, Kanagawa, Japan
| | - Shiei Kim
- Department of Emergency and Critical Care Medicine, Nippon Medical School Hospital, Tokyo, Japan
| | - Yuta Moroe
- Department of Emergency and Critical Care Medicine, Nippon Medical School Tama Nagayama Hospital, Tokyo, Japan
| | - Reo Fukuda
- Department of Emergency and Critical Care Medicine, Nippon Medical School Tama Nagayama Hospital, Tokyo, Japan
| | - Kyoko Unemoto
- Department of Emergency and Critical Care Medicine, Nippon Medical School Tama Nagayama Hospital, Tokyo, Japan
| | - Hiroyuki Yokota
- Department of Emergency and Critical Care Medicine, Nippon Medical School Musashikosugi Hospital, Kanagawa, Japan
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17
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Inokuchi S, Masui Y, Miura K, Tsutsumi H, Takuma K, Atsushi I, Nakano M, Tanaka H, Ikegami K, Arai T, Yaguchi A, Kitamura N, Oda S, Kobayashi K, Suda T, Ono K, Morimura N, Furuya R, Koido Y, Iwase F, Nagao K, Kanesaka S, Okada Y, Unemoto K, Sadahiro T, Iyanaga M, Muraoka A, Hayashi M, Ishimatsu S, Miyake Y, Yokokawa H, Koyama Y, Tsuchiya A, Kashiyama T, Hayashi M, Oshima K, Kiyota K, Hamabe Y, Yokota H, Hori S, Inaba S, Sakamoto T, Harada N, Kimura A, Kanai M, Otomo Y, Sugita M, Kinoshita K, Sakurai T, Kitano M, Matsuda K, Tanaka K, Yoshihara K, Yoh K, Suzuki J, Toyoda H, Mashiko K, Shimizu N, Muguruma T, Shimada T, Kobe Y, Shoko T, Nakanishi K, Shiga T, Yamamoto T, Sekine K, Izuka S. A New Rule for Terminating Resuscitation of Out-of-Hospital Cardiac Arrest Patients in Japan: A Prospective Study. J Emerg Med 2017; 53:345-352. [DOI: 10.1016/j.jemermed.2017.05.025] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2016] [Revised: 05/05/2017] [Accepted: 05/30/2017] [Indexed: 11/24/2022]
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Tagami T, Matsui H, Tanaka C, Kaneko J, Kuno M, Ishinokami S, Unemoto K, Fushimi K, Yasunaga H. Amiodarone Compared with Lidocaine for Out-Of-Hospital Cardiac Arrest with Refractory Ventricular Fibrillation on Hospital Arrival: a Nationwide Database Study. Cardiovasc Drugs Ther 2017; 30:485-491. [PMID: 27618826 DOI: 10.1007/s10557-016-6689-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
PURPOSE The latest resuscitation guidelines recommend the use of amiodarone in adult patients with out-of-hospital cardiac arrest (OHCA) and refractory ventricular fibrillation (VF) to improve the rates of return of spontaneous circulation. However, there is limited evidence to suggest that amiodarone is superior to lidocaine with respect to survival at discharge. The purpose of the present study was to evaluate the hypothesis that amiodarone is superior to lidocaine with regard to the rate of survival to hospital discharge for OHCA patients with VF/pulseless VT (pVT) on hospital arrival. METHODS Using the Japanese Diagnosis Procedure Combination inpatient database, we identified 3951 patients from 795 hospitals who experienced cardiogenic OHCA and had refractory ventricular fibrillation on hospital arrival between July 2007 and March 2013. The patients were categorized into amiodarone (n = 1743) and lidocaine (n = 2208) groups, from which 801 propensity score-matched pairs were generated. RESULTS There was no significant difference in the rate of survival to hospital discharge between the amiodarone and lidocaine groups (15.2 % vs. 17.1 %; difference, -1.9 %; 95 % CI, -5.5 to 1.7) in propensity score-matched analyses. Cox regression analyses did not indicate significant in-hospital mortality differences between the amiodarone and lidocaine groups for the propensity score-matched groups (hazard ratio, 1.05; 95 % CI, 0.94 to 1.17). CONCLUSIONS The present nationwide study suggested that there was no significant difference in the rate of survival to hospital discharge between cardiogenic OHCA patients with persistent ventricular fibrillation on hospital arrival treated with amiodarone or lidocaine.
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Affiliation(s)
- Takashi Tagami
- Department of Clinical Epidemiology and Health Economics, School of Public Health, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 1138555, Japan. .,Department of Emergency and Critical Care Medicine, Nippon Medical School Tama Nagayama Hospital, Tokyo, Japan.
| | - Hiroki Matsui
- Department of Clinical Epidemiology and Health Economics, School of Public Health, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 1138555, Japan
| | - Chie Tanaka
- Department of Emergency and Critical Care Medicine, Nippon Medical School Tama Nagayama Hospital, Tokyo, Japan
| | - Junya Kaneko
- Department of Emergency and Critical Care Medicine, Nippon Medical School Tama Nagayama Hospital, Tokyo, Japan
| | - Masamune Kuno
- Department of Emergency and Critical Care Medicine, Nippon Medical School Tama Nagayama Hospital, Tokyo, Japan
| | - Saori Ishinokami
- Department of Emergency and Critical Care Medicine, Nippon Medical School Tama Nagayama Hospital, Tokyo, Japan
| | - Kyoko Unemoto
- Department of Emergency and Critical Care Medicine, Nippon Medical School Tama Nagayama Hospital, Tokyo, Japan
| | - Kiyohide Fushimi
- Department of Health Informatics and Policy, Graduate School of Medicine, Tokyo Medical and Dental University, Tokyo, Japan
| | - Hideo Yasunaga
- Department of Clinical Epidemiology and Health Economics, School of Public Health, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 1138555, Japan
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Tagami T, Matsui H, Moroe Y, Fukuda R, Shibata A, Tanaka C, Unemoto K, Fushimi K, Yasunaga H. Antithrombin use and 28-day in-hospital mortality among severe-burn patients: an observational nationwide study. Ann Intensive Care 2017; 7:18. [PMID: 28220452 PMCID: PMC5318343 DOI: 10.1186/s13613-017-0244-y] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [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: 10/08/2016] [Accepted: 02/10/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Previous studies have suggested that antithrombin may be beneficial for treating coagulopathy in patients with severe burns. However, robust evidence for this idea is lacking. We examined the hypothesis that antithrombin may be effective in treating patients with severe burns. METHODS We performed propensity score-matched analyses of the nationwide administrative Japanese Diagnosis Procedure Combination inpatient database. We identified patients with severe burns (burn index ≥ 10) who were recorded in the database from 1 July 2010 to 31 March 2013. We compared patients who were administered antithrombin within 2 days of admission (antithrombin group) and those who were not administered antithrombin (control group). The main outcomes were 28-day mortality and ventilator-free days (VFDs). RESULTS Eligible patients (n = 3223) from 618 hospitals were categorized into either an antithrombin group (n = 152) or control group (n = 3071). Propensity score matching created a matched cohort of 103 pairs with and without antithrombin. Twenty-eight-day mortality was lower in the antithrombin group compared with the control group in propensity-matched analysis (control vs. antithrombin, 47.6 vs. 33.0%; difference, 14.6%; 95% confidence interval [CI] 1.2-28.0). Cox regression analysis showed a significant difference in 28-day in-hospital mortality between the control and antithrombin propensity-matched groups (hazard ratio 0.58; 95% CI 0.37-0.90). There were significantly more VFDs in the antithrombin compared with the control group in propensity score-matched analysis (control vs. antithrombin, 12.6 vs. 16.4 days; difference -3.7; 95% CI -7.2 to -0.12). CONCLUSIONS This nationwide database study demonstrated that antithrombin use may improve 28-day survival and increase VFDs in patients with severe burns. Further prospective studies are required to confirm these results.
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Affiliation(s)
- Takashi Tagami
- Department of Clinical Epidemiology and Health Economics, School of Public Health, Graduate School of Medicine, University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 1138555, Japan. .,Department of Emergency and Critical Care Medicine, Nippon Medical School Tama Nagayama Hospital, Tokyo, Japan.
| | - Hiroki Matsui
- Department of Clinical Epidemiology and Health Economics, School of Public Health, Graduate School of Medicine, University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 1138555, Japan
| | - Yuuta Moroe
- Department of Emergency and Critical Care Medicine, Nippon Medical School Tama Nagayama Hospital, Tokyo, Japan
| | - Reo Fukuda
- Department of Emergency and Critical Care Medicine, Nippon Medical School Tama Nagayama Hospital, Tokyo, Japan
| | - Ami Shibata
- Department of Emergency and Critical Care Medicine, Nippon Medical School Tama Nagayama Hospital, Tokyo, Japan
| | - Chie Tanaka
- Department of Emergency and Critical Care Medicine, Nippon Medical School Tama Nagayama Hospital, Tokyo, Japan
| | - Kyoko Unemoto
- Department of Emergency and Critical Care Medicine, Nippon Medical School Tama Nagayama Hospital, Tokyo, Japan
| | - Kiyohide Fushimi
- Department of Health Informatics and Policy, Tokyo Medical and Dental University Graduate School of Medicine, Tokyo, Japan
| | - Hideo Yasunaga
- Department of Clinical Epidemiology and Health Economics, School of Public Health, Graduate School of Medicine, University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 1138555, Japan
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Tagami T, Matsui H, Kuno M, Moroe Y, Kaneko J, Unemoto K, Fushimi K, Yasunaga H. Early antibiotics administration during targeted temperature management after out-of-hospital cardiac arrest: a nationwide database study. BMC Anesthesiol 2016; 16:89. [PMID: 27717334 PMCID: PMC5055699 DOI: 10.1186/s12871-016-0257-3] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2016] [Accepted: 09/28/2016] [Indexed: 12/12/2022] Open
Abstract
Background Patients resuscitated after cardiac arrest are reportedly at high risk for infection and sepsis, especially those treated with targeted temperature management (TTM). There is, however, limited evidence suggesting that early antibiotic use improves patient outcomes. We examined the hypothesis that early treatment with antibiotics reduces mortality in patients with cardiac arrest receiving TTM. Methods We identified 2803 patients with cardiogenic out-of-hospital cardiac arrest (OHCA) that were treated with TTM and were admitted to 371 hospitals that contribute to the Japanese Diagnosis Procedure Combination inpatient database between July 2007 and March 2013. Of these, 1272 received antibiotics within the first 2 days (antibiotics) and 1531 did not (control). We generated 802 propensity score-matched pairs. Results There was no significant difference in 30-day mortality between the groups (control vs. antibiotics; 33.0 % vs. 29.9 %; difference, 3.1 %; 95 % confidence interval [CI], −1.4 to 7.7 %, p = 0.18). Analysis using the hospital antibiotics prescribing rate as an instrumental variable showed that antibiotic use was not significantly associated with a reduction in 30-day mortality (6.6 %, CI 95 %, −0.5 to 13.7 %, p = 0.28). A subgroup analysis of patients who required extracorporeal membrane oxygenation (ECMO) indicated a significant difference in 30-day mortality between the 2 groups (62.9 % vs. 43.5 %; difference 19.3 %, CI 95 %, 5.9 to 32.7 %, p = 0.005). In the instrumental variable model, the estimated reduction in 30-day mortality associated with antibiotics was 18.2 % (CI 95 %, 21.3 to 34.4 %, p = 0.03) in ECMO patients. Conclusions Although there was no significant association between the use of antibiotics and mortality after overall cardiogenic OHCA treated with TTM, antibiotics may be beneficial in patients who require ECMO.
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Affiliation(s)
- Takashi Tagami
- Department of Clinical Epidemiology and Health Economics, School of Public Health, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 1138555, Japan. .,Department of Emergency and Critical Care Medicine, Nippon Medical School Tama Nagayama Hospital, 1-7-1 Nagayama, Tama-shi, Tokyo, 2068512, Japan.
| | - Hiroki Matsui
- Department of Clinical Epidemiology and Health Economics, School of Public Health, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 1138555, Japan
| | | | - Yuuta Moroe
- Department of Emergency and Critical Care Medicine, Nippon Medical School Tama Nagayama Hospital, 1-7-1 Nagayama, Tama-shi, Tokyo, 2068512, Japan
| | - Junya Kaneko
- Department of Emergency and Critical Care Medicine, Nippon Medical School Tama Nagayama Hospital, 1-7-1 Nagayama, Tama-shi, Tokyo, 2068512, Japan
| | - Kyoko Unemoto
- Department of Emergency and Critical Care Medicine, Nippon Medical School Tama Nagayama Hospital, 1-7-1 Nagayama, Tama-shi, Tokyo, 2068512, Japan
| | - Kiyohide Fushimi
- Department of Health Informatics and Policy, Graduate School of Medicine, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyoku, Tokyo, 1138510, Japan
| | - Hideo Yasunaga
- Department of Clinical Epidemiology and Health Economics, School of Public Health, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 1138555, Japan
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Tagami T, Matsui H, Ishinokami S, Oyanagi M, Kitahashi A, Fukuda R, Unemoto K, Fushimi K, Yasunaga H. Amiodarone or nifekalant upon hospital arrival for refractory ventricular fibrillation after out-of-hospital cardiac arrest. Resuscitation 2016; 109:127-132. [PMID: 27568110 DOI: 10.1016/j.resuscitation.2016.08.017] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2016] [Revised: 08/02/2016] [Accepted: 08/10/2016] [Indexed: 12/11/2022]
Abstract
BACKGROUND We evaluated the association between nifekalant or amiodarone on hospital admission and in-hospital mortality for cardiac arrest patients with persistent ventricular fibrillation on hospital arrival. METHODS This was a retrospective cohort study using the Japanese Diagnosis Procedure Combination inpatient database. We identified 2961 patients who suffered cardiogenic out-of-hospital cardiac arrest and who had ventricular fibrillation on hospital arrival between July 2007 and March 2013. Patients were categorized into amiodarone (n=2353) and nifekalant (n=608) groups, from which 525 propensity score-matched pairs were generated. RESULTS We found a significant difference in the admission rate between the nifekalant and amiodarone groups in propensity score-matched groups (75.6% vs. 69.3%, respectively; difference, 6.3%; 95% confidence interval (CI), 0.9-11.7). An analysis using the hospital nifekalant/amiodarone rate as an instrumental variable found that receiving nifekalant was associated with an improved admission rate (22.2%, 95% CI, 11.9-32.4). We found no significant difference in in-hospital mortality between the nifekalant and amiodarone groups (81.5% vs. 82.1%, respectively; difference, -0.6%; 95% CI, -5.2 to 4.1). Instrumental variable analysis showed that receiving nifekalant was not associated with reduced in-hospital mortality (6.2%, 95% CI, -2.4 to 14.8). CONCLUSIONS This nationwide study suggested no significant in-hospital mortality association between nifekalant and amiodarone for cardiogenic out-of-hospital cardiac arrest patients with ventricular fibrillation/persistent ventricular tachycardia on hospital arrival. Although nifekalant may potentially improve hospital admission rates compared with amiodarone for these patients, further studies are required to confirm our results.
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Affiliation(s)
- Takashi Tagami
- Department of Clinical Epidemiology and Health Economics, School of Public Health, Graduate School of Medicine, The University of Tokyo, Japan; Department of Emergency and Critical Care Medicine, Nippon Medical School Tama Nagayama Hospital, Japan.
| | - Hiroki Matsui
- Department of Clinical Epidemiology and Health Economics, School of Public Health, Graduate School of Medicine, The University of Tokyo, Japan
| | - Saori Ishinokami
- Department of Emergency and Critical Care Medicine, Nippon Medical School Tama Nagayama Hospital, Japan
| | - Masao Oyanagi
- Department of Emergency and Critical Care Medicine, Nippon Medical School Tama Nagayama Hospital, Japan
| | - Akiko Kitahashi
- Department of Emergency and Critical Care Medicine, Nippon Medical School Tama Nagayama Hospital, Japan
| | - Reo Fukuda
- Department of Emergency and Critical Care Medicine, Nippon Medical School Tama Nagayama Hospital, Japan
| | - Kyoko Unemoto
- Department of Emergency and Critical Care Medicine, Nippon Medical School Tama Nagayama Hospital, Japan
| | - Kiyohide Fushimi
- Department of Health Informatics and Policy, Tokyo Medical and Dental University, Graduate School of Medicine, Japan
| | - Hideo Yasunaga
- Department of Clinical Epidemiology and Health Economics, School of Public Health, Graduate School of Medicine, The University of Tokyo, Japan
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Inokuchi S, Masui Y, Miura K, Tsutsumi H, Takuma K, Atsushi I, Nakano M, Tanaka H, Ikegami K, Arai T, Yaguchi A, Kitamura N, Oda S, Kobayashi K, Suda T, Ono K, Morimura N, Furuya R, Koido Y, Iwase F, Nagao K, Kanesaka S, Okada Y, Unemoto K, Sadahiro T, Iyanaga M, Muraoka A, Hayashi M, Ishimatsu S, Miyake Y, Yokokawa H, Koyama Y, Tsuchiya A, Kashiyama T, Hayashi M, Oshima K, Kiyota K, Hamabe Y, Yokota H, Hori S, Inaba S, Sakamoto T, Harada N, Kimura A, Kanai M, Otomo Y, Sugita M, Kinoshita K, Sakurai T, Kitano M, Matsuda K, Tanaka K, Yoshihara K, Yoh K, Suzuki J, Toyoda H, Mashiko K, Shimizu N, Muguruma T, Shimada T, Kobe Y, Shoko T, Nakanishi K, Shiga T, Yamamoto T, Sekine K, Izuka S. Investigation and treatment of pulmonary embolism as a potential etiology may be important to improve post-resuscitation prognosis in non-shockable out-of-hospital cardiopulmonary arrest: report on an analysis of the SOS-KANTO 2012 study. Acute Med Surg 2016; 3:250-259. [PMID: 29123793 DOI: 10.1002/ams2.183] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2015] [Accepted: 11/16/2015] [Indexed: 11/05/2022] Open
Abstract
Background The prognosis of non-shockable out-of-hospital cardiac arrest is worse than that of shockable out-of-hospital cardiac arrest. We investigated the associations between the etiology and prognosis of non-shockable out-of-hospital cardiac arrest patients who experienced the return of spontaneous circulation after arriving at hospital. Methods and Results All subjects were extracted from the SOS-KANTO 2012 study population. The subjects were 3,031 adults: (i) who had suffered out-of-hospital cardiac arrest, (ii) for whom there were no pre-hospital data on ventricular fibrillation/pulseless ventricular tachycardia until arrival at hospital, (iii) who experienced the return of spontaneous circulation after arriving at hospital. We compared the patients' prognosis after 1 and 3 months between various etiological and presumed cardiac factors. The proportion of the favorable brain function patients that developed pulmonary embolism or incidental hypothermia was significantly higher than that of the patients with presumed cardiac factors (1 month, P < 0.0001 and P < 0.0001, respectively; 3 months, P = 0.0018 and P < 0.0001, respectively). In multiple logistic regression analysis, pulmonary embolism and incidental hypothermia were found to be significant independent prognostic factors for 1- and 3-month survival and the favorable brain function rate. Conclusions In patients who suffer non-shockable out-of-hospital cardiac arrest, but who experience the return of spontaneous circulation after arriving at hospital, the investigation and treatment of pulmonary embolism as a potential etiology may be important for improving post-resuscitation prognosis.
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Affiliation(s)
| | | | - Yoshihiro Masui
- St. Marianna University School of Medicine Yokohama Seibu Hospital
| | | | | | | | | | | | | | | | - Takao Arai
- Hachioji Medical Center of Tokyo Medical University
| | | | | | - Shigeto Oda
- Chiba University Graduate School of Medicine
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Akio Kimura
- National Center for Global Health and Medicine Hospital
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Shinichi Izuka
- Fuji Heavy Industries Health Insurance Society OTA Memorial Hospital
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Irahara T, Sato N, Moroe Y, Fukuda R, Iwai Y, Unemoto K. Retrospective study of the effectiveness of Intra-Aortic Balloon Occlusion (IABO) for traumatic haemorrhagic shock. World J Emerg Surg 2015; 10:1. [PMID: 25598838 PMCID: PMC4297416 DOI: 10.1186/1749-7922-10-1] [Citation(s) in RCA: 53] [Impact Index Per Article: 5.9] [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: 10/08/2014] [Accepted: 12/26/2014] [Indexed: 11/10/2022] Open
Abstract
Introduction Intra-aortic balloon occlusion (IABO) is useful for proximal vascular control, by clamping the descending aorta, in traumatic haemorrhagic shock. However, there are limited clinical studies regarding its effectiveness. This study aimed at investigating the effectiveness of IABO for traumatic haemorrhagic shock. Methods This retrospective, observational study included trauma patients who underwent IABO at the Emergency and Critical Care Center of Nippon Medical School Tama-Nagayama Hospital between January 2009 and March 2013. 14 patients were included to this study who were in shock on arrival (systolic blood pressure [SBP] <90 mmHg or shock index ≥1), underwent IABO for resuscitation and temporary haemostasis, and subsequently underwent haemostatic intervention (operation or transcatheter arterial embolization). Patient characteristics, physiological status, SBP, heart rate (HR), initial fluid and blood transfusion, time course, and total occlusion time were compared before and after IABO as well as between the survived (n = 5) and non-survived (n = 9) groups. Results The majority of patients experienced blunt injuries, with an average injury severity score of 29.5. The liver, pelvis, spleen, and mesenterium represented the majority of injured organs. SBP, but not HR, was significantly higher after IABO than before IABO (123.1 vs. 65.5 mmHg, P = 0.0001). The revised trauma score and probability of survival were significantly different between the survived and non-survived groups (both, P = 0.04). The survived group required significantly less blood transfusion volume than the non-survived group (20 vs. 33.7 red blood cell units, P = 0.04). In addition, the survived group required a significantly shorter total occlusion time than the non-survived group (46.2 vs. 224.1 min, P = 0.002). Conclusions IABO was used for relatively severe trauma patients. SBP was significantly higher after IABO, but was not related to survival. However, blood transfusion volume and total occlusion time were related to survival; therefore, it is important to reduce or shorten these parameters, i.e., immediate definitive haemostasis. IABO is effective for traumatic haemorrhagic shock; however, it is also important to consider these points and potential complications.
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Affiliation(s)
- Takayuki Irahara
- Graduate School of Emergency and Critical Care Medicine, Nippon Medical School, Tokyo, Japan
| | - Norio Sato
- Department of Primary Care and Emergency Medicine, Kyoto University, Kyoto, Japan
| | - Yuuta Moroe
- Emergency and Critical Care Center, Nippon Medical School Tama- Nagayama Hospital, Tokyo, Japan
| | - Reo Fukuda
- Emergency and Critical Care Center, Nippon Medical School Tama- Nagayama Hospital, Tokyo, Japan
| | - Yusuke Iwai
- Emergency and Critical Care Center, Nippon Medical School Tama- Nagayama Hospital, Tokyo, Japan
| | - Kyoko Unemoto
- Emergency and Critical Care Center, Nippon Medical School Tama- Nagayama Hospital, Tokyo, Japan
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Unemoto K, Yokota H. [Present state of initial treatment of neurological abnormalities and the development faculties of emergency physicians]. Brain Nerve 2010; 62:35-42. [PMID: 20112790] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
In an emergency room, attending doctors encounter various neurological symptoms and signs on a daily basis. Every doctor aims to identify abnormal findings, achieve a diagnosis, and offer appropriate management. In Japan, currently, only approximately 35% of leading emergency centers have neurologists, neurosurgeons, and psychiatrists performing exclusive functions. Therefore, the initial or tentative diagnosis of a patient with cerebral symptoms is dealt by emergency physicians. For instance, in a patient presenting with hemiparesis, prompt detection of an acute cerebral infarction, which has a highly limited therapeutic window for thrombolytic therapy, is crucial. However, this symptom may also be observed in some cases of severe hypoglycemia, psychogenic reaction (conversion hysteria), etc. This report describes a strategy for accurate diagnosis and medical treatment of neurological abnormalities at the emergency rooms of hospitals, which are expected to provide this support.
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Affiliation(s)
- Kyoko Unemoto
- Department of Emergency and Critical Care Medicine, Nippon Medical School, Musashikosugi Hospital, 1-396 Musashikosugi, Nakahara-ku, Kawasaki, Kanagawa 211-8533, Japan
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Yokota H, Naoe Y, Nakabayashi M, Unemoto K, Kushimoto S, Kurokawa A, Node Y, Yamamoto Y. Cerebral endothelial injury in severe head injury: the significance of measurements of serum thrombomodulin and the von Willebrand factor. J Neurotrauma 2002; 19:1007-15. [PMID: 12482114 DOI: 10.1089/089771502760341929] [Citation(s) in RCA: 51] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Thrombomodulin (TM), which is located in the surface of the endothelium in the arteries, veins, and capillaries of major organs such as the brain, lungs, liver, kidneys, skeletal muscles, and gastrointestinal tract, is one of several indicators of endothelial injury. Von Willebrand factor (vWf), which is synthesized by endothelial cells, is also an endothelial specific glycoprotein. The serum level of vWf increases in response to various stimuli without endothelial injury. An elevated serum level of vWf may suggest endothelial activation in severe head injury. We hypothesize that the degree of cerebral endothelial activation or injury depends on the type of head injury and that measuring the TM and vWf is useful for predicting delayed traumatic intracerebral hematoma (DTICH), produced by weakness of the vessel wall, occuring either as a direct or indirect effect of head injury. The values of vWf in focal brain injury (ranging from 332.5 +/- 52.8% to 361.7 +/- 86.2%) were significantly higher than those in diffuse axonal injury from 2 h to 7 days after the injury occurred (ranging from 201.6 +/- 59.5% to 242.5 +/- 51.7%). The serum level of TM in focal brain injury (ranging from 3.84 +/- 1.54 to 4.12 +/- 1.46 U/mL) was higher than that in diffuse axonal injury (ranging from 2.96 +/- 0.63 to 3.67 +/- 1.70 U/mL), but these differences were not statistically significant. In patients with DTICH, TM was significantly higher than in patients without DTICH (p < 0.01). The results of our study demonstrate that the degree of endothelial activation in focal brain injury was significantly higher than in diffuse brain injury. In addition, the serum level of TM in patients with DTICH was significantly higher than in patients without DTICH. These findings suggest that cerebral tissue injury is often accompanied by cerebral endothelial activation, and that these two phenomena should be distinguished from each other. The levels of serum TM and vWf appear to be good indicators of the cerebral endothelial injury and of endothelial activation in severe head injury.
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Affiliation(s)
- Hiroyuki Yokota
- Department of Emergency and Critical Care, Tama-Nagayama Hospital, Nippon Medical School, Tokyo, Japan.
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Abstract
PURPOSE The aim of this study was to see if allogeneic transplantation (Tx) of newborn esophagus can create viable esophageal tissue that may be used for treating long gap esophageal atresia. METHODS Specimens of thoracic esophagus from newborn Brown-Norway rats, each were transplanted into a pouch created in the distal omentum of 5-week-old Lewis rats. In group I no immunosuppressant was used. FK-506 was used in group II (0.2 mg/kg), group III (0.6 mg/kg), and group IV (1.2 mg/kg) until a predetermined day of graft harvesting (1, 2, 3, 4, 5, 6, and 8 weeks after Tx). FK-506 was used for only 2 weeks in group V (0.6 mg/kg), and group VI (1.2mg/kg), and transplanted esophageal grafts were harvested 1, 2, 3, and 4 weeks after cessation of 2 weeks course FK-506. Syngeneic esophagus transplants were used as controls. All grafts were examined by H&E staining to assess graft viability and degree of rejection. RESULTS Each successfully transplanted esophagus appeared macroscopically as a tube like mass. Each graft could be mobilized to the thoracic cavity, because of the long omental pedicle. Graft survival in the control group was 100%. Rejection was observed in all grafts from groups I, II, V, and VI. In contrast, grafts from groups III and IV showed only minimal or no rejection. There was no evidence of side effects of FK-506 in rats in groups III and IV, except significantly slower weight gain compared with controls (P <.05). CONCLUSIONS FK-506 successfully prevented rejection, although immunologic tolerance was not achieved. These observations suggest that the authors' procedure has the potential to produce viable esophageal tissue that could be a new option for treating long gap esophageal atresia.
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Affiliation(s)
- A Yamataka
- Department of Pediatric Surgery, Juntendo University School of Medicine, Tokyo, Japan
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Yokota H, Yamamoto Y, Naoe Y, Fuse A, Sato H, Unemoto K, Kurokawa A. Measurements of cortical cellular pH by intracranial tonometer in severe head injury. Crit Care Med 2000; 28:3275-80. [PMID: 11008992 DOI: 10.1097/00003246-200009000-00025] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To evaluate the cortical cellular damage in acute severe head injury, we measured the cortical cellular pH by using an intracranial tonometer made in our institution. DESIGN Prospective, 3.5-yr data collection. SETTING University hospital trauma intensive care unit. PATIENTS Severely head-injured patients (n = 29) with Glasgow Coma Scale score <8. INTERVENTION Routine emergency neurologic procedure. MEASUREMENTS AND MAIN RESULTS We made 98 measurements of cortical cellular pH by intracranial tonometer in 29 severely head-injured patients in the acute phase. Each patient's intracranial pressure was recorded, and in 16 patients, the saturation of jugular venous oxygen was monitored. The outcome at 6 months after injury was significantly better in patients having a cortical cellular pH of >7.2 than those with <7.2. The cerebral perfusion pressure and cortical cellular pH correlated significantly (p < .0001). CONCLUSIONS Our study suggests the usefulness of measurement of cortical cellular pH by intracranial tonometer for evaluating the severity of focal anaerobic cerebral metabolism and predicting patient prognosis.
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Affiliation(s)
- H Yokota
- Department of Emergency and Critical Care Medicine, Tama-Nagayama Hospital, Nippon Medical School, Tama-city, Tokyo, Japan
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