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Misumi K, Hagiwara Y, Kimura T, Hifumi T, Inoue A, Sakamoto T, Kuroda Y, Ogura T. Impact of center volume on in-hospital mortality in adult patients with out‑of‑hospital cardiac arrest resuscitated using extracorporeal cardiopulmonary resuscitation: a secondary analysis of the SAVE-J II study. Sci Rep 2024; 14:8309. [PMID: 38594325 PMCID: PMC11003956 DOI: 10.1038/s41598-024-58808-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2023] [Accepted: 04/03/2024] [Indexed: 04/11/2024] Open
Abstract
Recently, patients with out-of-hospital cardiac arrest (OHCA) refractory to conventional resuscitation have started undergoing extracorporeal cardiopulmonary resuscitation (ECPR). However, the mortality rate of these patients remains high. This study aimed to clarify whether a center ECPR volume was associated with the survival rates of adult patients with OHCA resuscitated using ECPR. This was a secondary analysis of a retrospective multicenter registry study, the SAVE-J II study, involving 36 participating institutions in Japan. Centers were divided into three groups according to the tertiles of the annual average number of patients undergoing ECPR: high-volume (≥ 21 sessions per year), medium-volume (11-20 sessions per year), or low-volume (< 11 sessions per year). The primary outcome was survival rate at the time of discharge. Patient characteristics and outcomes were compared among the three groups. Moreover, a multivariable-adjusted logistic regression model was applied to study the impact of center ECPR volume. A total of 1740 patients were included in this study. The center ECPR volume was strongly associated with survival rate at the time of discharge; furthermore, survival rate was best in high-volume compared with medium- and low-volume centers (33.4%, 24.1%, and 26.8%, respectively; P = 0.001). After adjusting for patient characteristics, undergoing ECPR at high-volume centers was associated with an increased likelihood of survival compared to middle- (adjusted odds ratio 0.657; P = 0.003) and low-volume centers (adjusted odds ratio 0.983; P = 0.006). The annual number of ECPR sessions was associated with favorable survival rates and lower complication rates of the ECPR procedure.Clinical trial registration: https://center6.umin.ac.jp/cgi-open-bin/ctr_e/ctr_view.cgi?recptno=R000041577 (unique identifier: UMIN000036490).
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Affiliation(s)
- Kayo Misumi
- Department of Emergency and Critical Care, Saiseikai Utsunomiya Hospital, 911-1, Takebayashi-machi, Utsunomiya, Tochigi, 321-0974, Japan
- Department of Cardiology, Saiseikai Utsunomiya Hospital, Utsunomiya, Japan
| | - Yoshihiro Hagiwara
- Department of Emergency and Critical Care, Saiseikai Utsunomiya Hospital, 911-1, Takebayashi-machi, Utsunomiya, Tochigi, 321-0974, Japan
| | - Takuya Kimura
- Department of Emergency and Critical Care, Saiseikai Utsunomiya Hospital, 911-1, Takebayashi-machi, Utsunomiya, Tochigi, 321-0974, Japan
| | - Toru Hifumi
- Department of Emergency and Critical Care Medicine, St. Luke's International Hospital, Tokyo, Japan
| | - Akihiko Inoue
- Department of Emergency and Critical Care Medicine, Hyogo Emergency Medical Center, Kobe, Japan
| | - Tetsuya Sakamoto
- Department of Emergency Medicine, Teikyo University School of Medicine, Tokyo, Japan
| | - Yasuhiro Kuroda
- Department of Emergency Medicine, Kagawa University School of Medicine, Kagawa, Japan
| | - Takayuki Ogura
- Department of Emergency and Critical Care, Saiseikai Utsunomiya Hospital, 911-1, Takebayashi-machi, Utsunomiya, Tochigi, 321-0974, Japan.
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Okada Y, Fujita K, Ogura T, Motomura T, Fukuyama Y, Banshotani Y, Tokuda R, Ijuin S, Inoue A, Takahashi H, Yokobori S. Novel and innovative resuscitation systems in Japan. Resusc Plus 2024; 17:100541. [PMID: 38260120 PMCID: PMC10801325 DOI: 10.1016/j.resplu.2023.100541] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2024] Open
Abstract
Aim Out-of-hospital cardiac arrest (OHCA) is a life-threatening emergency that requires rapid and efficient intervention. Recently, several novel approaches have emerged and have been incorporated into resuscitation systems in some local areas of Japan. This review describes innovative resuscitation systems and highlights their strengths. Main text First, we discuss the deployment of a physician-staffed ambulance, in which emergency physicians offer advanced resuscitation to patients with OHCA on site. In addition, we describe the experimental practice of extracorporeal membrane oxygenation (ECPR) in a prehospital setting. Second, we describe a physician-staffed helicopter, wherein a medical team provides advanced resuscitation at the scene. We also explain their initiative to provide early ECPR, even in remote areas. Finally, we provide an overview of the "hybrid ER" system which is a "one-fits-all" resuscitation bay equipped with computed tomography and fluoroscopy equipment. This system is expected to help swiftly identify and rule out irreversible causes of cardiac arrest, such as massive subarachnoid hemorrhage, and implement ECPR without delay. Conclusion Although these revolutionary approaches may improve the outcomes of patients with OHCA, evidence of their effectiveness remains limited. In addition, it is crucial to ensure cost-effectiveness and sustainability. We will continue to work diligently to assess the effectiveness of these systems and focus on the development of cost-effective and sustainable systems.
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Affiliation(s)
- Yohei Okada
- Health Services and Systems Research, Duke-NUS Medical School, Singapore
- Department of Preventive Services, Kyoto University, Kyoto, Japan
| | - Kensuke Fujita
- Department of Emergency Medicine and Critical Care Medicine, Tochigi Prefectural Emergency and Critical Care Center, Imperial Gift Foundation Saiseikai Utsunomiya Hospital, Japan
| | - Takayuki Ogura
- Department of Emergency Medicine and Critical Care Medicine, Tochigi Prefectural Emergency and Critical Care Center, Imperial Gift Foundation Saiseikai Utsunomiya Hospital, Japan
| | - Tomokazu Motomura
- Shock and Trauma Center/Hokusoh HEMS Nippon Medical School Chiba Hokusoh Hospital, Chiba, Japan
| | - Yuita Fukuyama
- Shock and Trauma Center/Hokusoh HEMS Nippon Medical School Chiba Hokusoh Hospital, Chiba, Japan
| | - Yuki Banshotani
- Tajima Emergency and Critical Care Medical Center, Hyogo, Japan
| | - Rina Tokuda
- Tajima Emergency and Critical Care Medical Center, Hyogo, Japan
| | - Shinichi Ijuin
- Department of Emergency and Critical Care Medicine, Hyogo Emergency Medical Center, Hyogo, Japan
| | - Akihiko Inoue
- Department of Emergency and Critical Care Medicine, Hyogo Emergency Medical Center, Hyogo, Japan
| | | | - Shoji Yokobori
- Department of Emergency and Critical Care Medicine Graduate School of Nippon Medical School, Tokyo, Japan
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Ohbe H, Hashimoto S, Ogura T, Nishikimi M, Kudo D, Shime N, Kushimoto S. Association between regional critical care capacity and the incidence of invasive mechanical ventilation for coronavirus disease 2019: a population-based cohort study. J Intensive Care 2024; 12:6. [PMID: 38287432 PMCID: PMC10826037 DOI: 10.1186/s40560-024-00718-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2023] [Accepted: 01/18/2024] [Indexed: 01/31/2024] Open
Abstract
BACKGROUND Coronavirus disease 2019 (COVID-19) has exposed critical care supply shortages worldwide. This study aimed to investigate the association between regional critical care capacity and the incidence of invasive mechanical ventilation following novel COVID-19 during the pandemic in Japan, a country with a limited intensive care unit (ICU) bed capacity of a median of 5.1 ICU beds per 100,000 individuals. METHODS This population-based cohort study used data from the CRoss Icu Searchable Information System database and publicly available databases provided by the Japanese government and Japanese Society of Intensive Care Medicine. We identified patients recently diagnosed with COVID-19, those who received invasive mechanical ventilation, and those who received extracorporeal membrane oxygenation (ECMO) between February 2020 and March 2023. We analyzed the association between regional critical care capacity (ICU beds, high-dependency care unit (HDU) beds, resource-rich ICU beds, and intensivists) and the incidence of invasive mechanical ventilation, ECMO, and risk-adjusted mortality across 47 Japanese prefectures. RESULTS Among the approximately 127 million individuals residing in Japan, 33,189,809 were recently diagnosed with COVID-19, with 12,203 and 1,426 COVID-19 patients on invasive mechanical ventilation and ECMO, respectively, during the study period. Prefecture-level linear regression analysis revealed that the addition of ICU beds, resource-rich ICU beds, and intensivists per 100,000 individuals increased the incidence of IMV by 5.37 (95% confidence interval, 1.99-8.76), 7.27 (1.61-12.9), and 13.12 (3.48-22.76), respectively. However, the number of HDU beds per 100,000 individuals was not statistically significantly associated with the incidence of invasive mechanical ventilation. None of the four indicators of regional critical care capacity was statistically significantly associated with the incidence of ECMO and risk-adjusted mortality. CONCLUSIONS The results of prefecture-level analyses demonstrate that increased numbers of ICU beds, resource-rich ICU beds, and intensivists are associated with the incidence of invasive mechanical ventilation among patients recently diagnosed with COVID-19 during the pandemic. These findings have important implications for healthcare policymakers, aiding in efficiently allocating critical care resources during crises, particularly in regions with limited ICU bed capacities. Registry and the registration no. of the study/trial The approval date of the registry was August 20, 2020, and the registration no. of the study was lUMIN000041450.
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Affiliation(s)
- Hiroyuki Ohbe
- Department of Emergency and Critical Care Medicine, Tohoku University Hospital, 1-1 Seiryo-Machi, Aoba-Ku, Sendai, 980-8574, Japan
- Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, 7-3-1 Hongo, Bunkyo-Ku, Tokyo, 113-0033, Japan
| | - Satoru Hashimoto
- Non-Profit Organization ICU Collaboration Network (ICON), Tokyo, Japan
| | - Takayuki Ogura
- Tochigi Prefectural Emergency and Critical Care Centre, Imperil Gift Foundation SAISEIKAI, Utsunomiya Hospital, 911-1 Takebayashi-Machi, Utsunomiya, 321-0974, Japan
| | - Mitsuaki Nishikimi
- Department of Emergency and Critical Care Medicine, Graduate School of Biomedical & Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-Ku, Hiroshima, 734-8551, Japan
| | - Daisuke Kudo
- Department of Emergency and Critical Care Medicine, Tohoku University Hospital, 1-1 Seiryo-Machi, Aoba-Ku, Sendai, 980-8574, Japan
- Division of Emergency and Critical Care Medicine, Tohoku University Graduate School of Medicine, 2-1 Seiryo-Machi, Aoba-Ku, Sendai, Miyagi, 980-8575, Japan
| | - Nobuaki Shime
- Department of Emergency and Critical Care Medicine, Graduate School of Biomedical & Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-Ku, Hiroshima, 734-8551, Japan
| | - Shigeki Kushimoto
- Department of Emergency and Critical Care Medicine, Tohoku University Hospital, 1-1 Seiryo-Machi, Aoba-Ku, Sendai, 980-8574, Japan.
- Division of Emergency and Critical Care Medicine, Tohoku University Graduate School of Medicine, 2-1 Seiryo-Machi, Aoba-Ku, Sendai, Miyagi, 980-8575, Japan.
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Misumi K, Hagiwara Y, Kimura T, Hifumi T, Inoue A, Sakamoto T, Kuroda Y, Ogura T. External Validation of the CAST and rCAST Score in Patients With Out-of-Hospital Cardiac Arrest Who Underwent Extracorporeal Cardiopulmonary Resuscitation: A Secondary Analysis of the SAVE-J II Study. J Am Heart Assoc 2024; 13:e031035. [PMID: 38156602 PMCID: PMC10863824 DOI: 10.1161/jaha.123.031035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2023] [Accepted: 12/01/2023] [Indexed: 12/30/2023]
Abstract
BACKGROUND Risk stratification is important in patients with post-cardiac arrest syndrome. The Post-Cardiac Arrest Syndrome for Therapeutic Hypothermia (CAST) and revised CAST (rCAST) scores have been well validated for predicting neurological outcomes, particularly for conventionally resuscitated patients with post-cardiac arrest syndrome. However, no studies have evaluated patients undergoing extracorporeal cardiopulmonary resuscitation. METHODS AND RESULTS Adult patients with out-of-hospital cardiac arrest who underwent extracorporeal cardiopulmonary resuscitation were analyzed in this retrospective observational multicenter cohort study. We validated the accuracy of the CAST/rCAST scores for predicting neurological outcomes at 30 days. Moreover, we compared the predictive performance of these scores with the TiPS65 risk score derived from patients with out-of-hospital cardiac arrest who were resuscitated using extracorporeal cardiopulmonary resuscitation. A total of 1135 patients were analyzed. The proportion of patients with favorable neurological outcomes was 16.6%. In the external validation, the area under the receiver operating characteristic curve of the CAST score was significantly higher than that of the rCAST score (area under the receiver operating characteristic curve 0.677 versus 0.603; P<0.001), but there was no significant difference with that of the TiPS65 score (versus 0.633; P=0.154). Both CAST/rCAST risk scores showed good calibration (Hosmer-Lemeshow test: P=0.726 and 0.674), and the CAST score showed significantly better predictability in net reclassification compared with the rCAST (P<0.001) and TiPS65 scores (P=0.001). CONCLUSIONS The prognostic accuracy of the CAST score was significantly better than that of other risk scores in net reclassification. The CAST score may help to predict neurological outcomes in patients with out-of-hospital cardiac arrest who undergo extracorporeal cardiopulmonary resuscitation. However, the predictive value of the CAST score was not sufficiently high for clinical application. REGISTRATION URL: https://center6.umin.ac.jp/cgi-open-bin/ctr_e/ctr_view.cgi?recptno=R000041577; Unique identifier: UMIN000036490.
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Affiliation(s)
- Kayo Misumi
- Department of Emergency and Critical CareSaiseikai Utsunomiya HospitalUtsunomiyaJapan
- Department of CardiologySaiseikai Utsunomiya HospitalUtsunomiyaJapan
| | - Yoshihiro Hagiwara
- Department of Emergency and Critical CareSaiseikai Utsunomiya HospitalUtsunomiyaJapan
| | - Takuya Kimura
- Department of Emergency and Critical CareSaiseikai Utsunomiya HospitalUtsunomiyaJapan
| | - Toru Hifumi
- Department of Emergency and Critical Care MedicineSt. Luke’s International HospitalTokyoJapan
| | - Akihiko Inoue
- Department of Emergency and Critical Care MedicineHyogo Emergency Medical CenterKobeJapan
| | - Tetsuya Sakamoto
- Department of Emergency MedicineTeikyo University School of MedicineTokyoJapan
| | - Yasuhiro Kuroda
- Department of Emergency MedicineKagawa University School of MedicineMikiKagawaJapan
| | - Takayuki Ogura
- Department of Emergency and Critical CareSaiseikai Utsunomiya HospitalUtsunomiyaJapan
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Suzuki J, Endo S, Suzuki T, Sasahara T, Hatakeyama S, Morisawa Y, Hayakawa M, Yamakawa K, Endo A, Ogura T, Hirayama A, Yasunaga H, Tagami T. Effect of Inhaled Ciclesonide in Non-Critically Ill Hospitalized Patients With Coronavirus Disease 2019: A Multicenter Observational Study in Japan. Open Forum Infect Dis 2023; 10:ofad571. [PMID: 38075018 PMCID: PMC10709541 DOI: 10.1093/ofid/ofad571] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Accepted: 11/14/2023] [Indexed: 12/30/2023] Open
Abstract
Background Coronavirus disease 2019 (COVID-19) is an ongoing global pandemic. Although systemic steroids play an important role in treating patients with severe COVID-19, the role of inhaled corticosteroids in non-critically ill, hospitalized patients with COVID-19 remains unclear. Methods We analyzed findings in non-critically ill, hospitalized patients with COVID-19 who were >18 years old and were admitted to 64 Japanese hospitals between January and September 2020. We performed propensity score matching analysis to evaluate 28-day and in-hospital mortality rates with or without inhaled ciclesonide within 2 days of admission. Sensitivity analyses using inverse probability weighting analysis, and generalized estimating equation method were also performed. Results Eligible patients (n = 3638) were divided into ciclesonide (n = 290) and control (n = 3, 393) groups. The 1-to-4 propensity score matching analysis included 271 ciclesonide users and 1084 nonusers. There were no significant differences between the 2 groups for 28-day (3.3% vs 2.3%; risk difference, 1.0% [95% confidence interval, -1.2 to 3.3]) or in-hospital (4.8% vs 2.6%; risk difference, 2.2 [-.5 to 4.9]) mortality rates. The sensitivity analysis showed similar outcomes. Conclusions From this multicenter observational study in Japan, inhaled ciclesonide did not decrease 28-day or in-hospital mortality rates in non-critically ill, hospitalized patients with COVID-19. Future large, multinational, randomized trials are required to confirm our results.
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Affiliation(s)
- Jun Suzuki
- Division of Infectious Diseases, Jichi Medical University Hospital, Shimotsuke, Tochigi, Japan
- Division of Infectious Diseases, Tohoku Medical and Pharmaceutical University Hospital, Sendai City, Miyagi, Japan
- Department of Infection Prevention and Control, Tohoku Medical and Pharmaceutical University Hospital, Sendai City, Miyagi, Japan
| | - Shiro Endo
- Division of Infectious Diseases, Tohoku Medical and Pharmaceutical University Hospital, Sendai City, Miyagi, Japan
- Department of Infection Prevention and Control, Tohoku Medical and Pharmaceutical University Hospital, Sendai City, Miyagi, Japan
- Division of Crisis Management Network for Infectious Diseases, Tohoku Medical and Pharmaceutical University, Sendai City, Miyagi, Japan
| | - Takayuki Suzuki
- Division of Infectious Diseases, Jichi Medical University Hospital, Shimotsuke, Tochigi, Japan
| | - Teppei Sasahara
- Division of Infectious Diseases, Jichi Medical University Hospital, Shimotsuke, Tochigi, Japan
- Department of Infection and Immunity, School of Medicine, Jichi Medical University, Shimotsuke, Tochigi, Japan
| | - Shuji Hatakeyama
- Division of Infectious Diseases, Jichi Medical University Hospital, Shimotsuke, Tochigi, Japan
- Division of General Internal Medicine, Jichi Medical University Hospital, Shimotsuke, Tochigi, Japan
| | - Yuji Morisawa
- Division of Infectious Diseases, Jichi Medical University Hospital, Shimotsuke, Tochigi, Japan
| | - Mineji Hayakawa
- Department of Emergency Medicine, Hokkaido University Hospital, Kita-ku, Sapporo, Japan
| | - Kazuma Yamakawa
- Department of Emergency and Critical Care Medicine, Osaka Medical and Pharmaceutical University, Osaka, Japan
| | - Akira Endo
- Trauma and Acute Critical Care Center, Tokyo Medical and Dental University Hospital, Bunkyo-ku, Tokyo, Japan
| | - Takayuki Ogura
- Department of Emergency Medicine and Critical Care Medicine, Tochigi Prefectural Emergency and Critical Care Centre, Imperial Foundation Saiseikai Utsunomiya Hospital, Utsunomiya, Tochigi, Japan
| | - Atsushi Hirayama
- Public Health, Department of Social Medicine, Graduate School of Medicine, Osaka University, Suita, Japan
| | - Hideo Yasunaga
- Department of Clinical Epidemiology and Health Economics, School of Public Health, University of Tokyo, Bunkyo-ku, Tokyo, Japan
| | - Takashi Tagami
- Department of Emergency and Critical Care Medicine, Nippon Medical School Musashikosugi Hospital, Kawasaki, Kanagawa, Japan
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Nakayama R, Bunya N, Tagami T, Hayakawa M, Yamakawa K, Endo A, Ogura T, Hirayama A, Yasunaga H, Uemura S, Narimatsu E. Associated organs and system with COVID-19 death with information of organ support: a multicenter observational study. BMC Infect Dis 2023; 23:814. [PMID: 37986049 PMCID: PMC10662555 DOI: 10.1186/s12879-023-08817-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2023] [Accepted: 11/13/2023] [Indexed: 11/22/2023] Open
Abstract
BACKGROUND The organ dysfunction that is associated with death in COVID-19 patients has not been determined in multicenter epidemiologic studies. In this study, we evaluated the major association with death, concomitant organ dysfunction, and proportion of multiple organ failure in deaths in patients with COVID-19, along with information on organ support. METHODS We performed an observational cohort study using the Japanese multicenter research of COVID-19 by assembling a real-world data (J-RECOVER) study database. This database consists of data on patients discharged between January 1 and September 31, 2020, with positive SARS-CoV-2 test results, regardless of intensive care unit admission status. These data were collected from the Diagnosis Procedure Combination and electronic medical records of 66 hospitals in Japan. The clinician identified and recorded the organ responsible for the death of COVID-19. RESULTS During the research period, 4,700 patients with COVID-19 were discharged from 66 hospitals participating in the J-RECOVER study; of which, 272 patients (5.8%) from 47 institutions who died were included in this study. Respiratory system dysfunction (87.1%) was the leading association with death, followed by cardiovascular (4.8%), central nervous (2.9%), gastrointestinal (2.6%), and renal (1.1%) dysfunction. Most patients (96.7%) who died of COVID-19 had respiratory system damage, and about half (48.9%) had multi-organ damage. Of the patients whose main association with death was respiratory dysfunction, 120 (50.6%) received mechanical ventilation. CONCLUSION This study showed that although respiratory dysfunction was the most common association with death in many cases, multi-organ dysfunction was associated with death due to COVID-19.
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Affiliation(s)
- Ryuichi Nakayama
- Department of Emergency Medicine, Sapporo Medical University School of Medicine, 291, Minami 1-jo Nishi 16-chome, Chuo-ku, Sapporo, Hokkaido, 060-8543, Japan
| | - Naofumi Bunya
- Department of Emergency Medicine, Sapporo Medical University School of Medicine, 291, Minami 1-jo Nishi 16-chome, Chuo-ku, Sapporo, Hokkaido, 060-8543, Japan.
| | - Takashi Tagami
- Department of Emergency and Critical Care Medicine, Nippon Medical School Musashikosugi Hospital, Tokyo, Japan
- Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, Tokyo, Japan
| | - Mineji Hayakawa
- Department of Emergency Medicine, Hokkaido University Hospital, Hokkaido, Japan
| | - Kazuma Yamakawa
- Department of Emergency Medicine, Osaka Medical and Pharmaceutical University, Osaka, Japan
| | - Akira Endo
- Trauma and Acute Critical Care Center, Tokyo Medical and Dental University Hospital, Tokyo, Japan
| | - Takayuki Ogura
- Department of Emergency Medicine and Critical Care Medicine, Tochigi Prefectural Emergency and Critical Care Centre, Imperial Foundation Saiseikai Utsunomiya Hospital, Tochigi, Japan
| | - Atsushi Hirayama
- Department of Social Medicine, Graduate School of Medicine, Public Health, Osaka University, Osaka, Japan
| | - Hideo Yasunaga
- Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, Tokyo, Japan
| | - Shuji Uemura
- Department of Emergency Medicine, Sapporo Medical University School of Medicine, 291, Minami 1-jo Nishi 16-chome, Chuo-ku, Sapporo, Hokkaido, 060-8543, Japan
| | - Eichi Narimatsu
- Department of Emergency Medicine, Sapporo Medical University School of Medicine, 291, Minami 1-jo Nishi 16-chome, Chuo-ku, Sapporo, Hokkaido, 060-8543, Japan
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7
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Nishikimi M, Ohshimo S, Hamaguchi J, Fujizuka K, Hagiwara Y, Anzai T, Ishii J, Ogata Y, Aokage T, Ikeda T, Yagi T, Suzuki G, Ishikura K, Katsuta K, Konno D, Hattori N, Nakamura T, Matsumura Y, Kasugai D, Kikuchi H, Iino T, Kai S, Hashimoto H, Yoshida T, Igarashi Y, Ogura T, Matsumura K, Shimizu K, Nakamura M, Ichiba S, Takahashi K, Shime N. High versus low positive end-expiratory pressure setting in patients receiving veno-venous extracorporeal membrane oxygenation support for severe acute respiratory distress syndrome: study protocol for the multicentre, randomised ExPress SAVER Trial. BMJ Open 2023; 13:e072680. [PMID: 37852764 PMCID: PMC10603413 DOI: 10.1136/bmjopen-2023-072680] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2023] [Accepted: 08/23/2023] [Indexed: 10/20/2023] Open
Abstract
INTRODUCTION While limiting the tidal volume to 6 mL/kg during veno-venous extracorporeal membrane oxygenation (V-V ECMO) to ameliorate lung injury in patients with acute respiratory distress syndrome (ARDS) is widely accepted, the best setting for positive end-expiratory pressure (PEEP) is still controversial. This study is being conducted to investigate whether a higher PEEP setting (15 cmH2O) during V-V ECMO can decrease the duration of ECMO support needed in patients with severe ARDS, as compared with a lower PEEP setting. METHODS AND ANALYSIS The study is an investigator-initiated, multicentre, open-label, two-arm, randomised controlled trial conducted with the participation of 20 intensive care units (ICUs) at academic as well as non-academic hospitals in Japan. The subjects of the study are patients with severe ARDS who require V-V ECMO support. Eligible patients will be randomised equally to the high PEEP group or low PEEP group. Recruitment to the study will continue until a total of 210 patients with ARDS requiring V-V ECMO support have been randomised. In the high PEEP group, PEEP will be set at 15 cmH2O from the start of V-V ECMO until the trials for liberation from V-V ECMO (or until day 28 after the allocation), while in the low PEEP group, the PEEP will be set at 5 cmH2O. Other treatments will be the same in the two groups. The primary endpoint of the study is the number of ECMO-free days until day 28, defined as the length of time (in days) from successful libration from V-V ECMO to day 28. The secondary endpoints are mortality on day 28, in-hospital mortality on day 60, ventilator-free days during the first 60 days and length of ICU stay. ETHICS AND DISSEMINATION Ethics approval for the trial at all the participating hospitals was obtained on 27 September 2022, by central ethics approval (IRB at Hiroshima University Hospital, C2022-0006). The results of this study will be presented at domestic and international medical congresses, and also published in scientific journals. TRIAL REGISTRATION NUMBER The Japan Registry of Clinical Trials jRCT1062220062. Registered on 28 September 2022. PROTOCOL VERSION 28 March 2023, version 4.0.
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Affiliation(s)
- Mitsuaki Nishikimi
- Department of Emergency and Critical Care Medicine, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Shinichiro Ohshimo
- Department of Emergency and Critical Care Medicine, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Jun Hamaguchi
- Department of Critical Care and Emergency Medicine, Tokyo Metropolitan Tama Medical Center, Tokyo, Japan
| | - Kenji Fujizuka
- Advanced Medical Emergency Department and Critical Care Center, Japan Red Cross Maebashi Hospital, Maebashi, Maebashi, UK
| | - Yoshihiro Hagiwara
- Department of Emergency Medicine and Critical Care Medicine, Saiseikai Utsunomiya Hospital, Utsunomiya, Japan
| | - Tatsuhiko Anzai
- Department of Biostatistics, M&D Data Science Center, Tokyo Medical and Dental University, Tokyo, Japan
| | - Junki Ishii
- Department of Emergency and Critical Care Medicine, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Yoshitaka Ogata
- Department of Critical Care Medicine, Yao Tokushukai General Hospital, Osaka, Japan
| | - Toshiyuki Aokage
- Department of Emergency, Critical Care and Disaster Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Tokuji Ikeda
- Department of Emergency Medicine and Critical Care Medicine, Yamanashi Prefectural Central Hospital, Kouhu, Japan
| | - Tsukasa Yagi
- Department of Cardiology, Nihon University Hospital, Tokyo, Japan
| | - Ginga Suzuki
- Emergency and Critical Care Center, Toho University Omori Medical Center, Tokyo, Japan
| | - Ken Ishikura
- Emergency and Disaster Medicine, Mie University Graduate School of Medicine, Tsu, Japan
| | - Ken Katsuta
- Department of Emergency and Critical Care, Tohoku University Hospital, Sendai, Japan
| | - Daisuke Konno
- Department of Anesthesiology and Perioperative Medicine, Tohoku University School of Medicine, Sendai, Japan
| | - Noriyuki Hattori
- Department of Emergency and Critical Care Medicine, Chiba University Graduate School of Medicine, Chiba, Japan
| | - Tomoyuki Nakamura
- Department of Anesthesiology and Critical Care Medicine, Fujita Health University School of Medicine, Toyoake, Japan
| | - Yosuke Matsumura
- Department of Intensive Care, Chiba Emergency Medical Center, Chiba, Chiba, Japan
| | - Daisuke Kasugai
- Department of Emergency and Critical Care Medicine, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Hitoshi Kikuchi
- Department of Emergency Medicine, Sagamihara Kyodo Hospital, Sagamihara, Japan
| | - Tatsuhiko Iino
- Department of Emergency Medicine, Kishiwada Tokushukai Hospital, Osaka, Japan
| | - Shinichi Kai
- Department of Anesthesia, Kyoto University School of Medicine, Kyoto, Japan
| | - Haruka Hashimoto
- Department of Anesthesia and Intensive Care Medicine, Osaka University School of Medicine, Osaka, Japan
| | - Takeshi Yoshida
- Department of Anesthesia and Intensive Care Medicine, Osaka University School of Medicine, Osaka, Japan
| | - Yumi Igarashi
- Department of Intensive Care Medicine, Showa University School of Medicine, Tokyo, Japan
| | - Takayuki Ogura
- Department of Emergency Medicine and Critical Care Medicine, Saiseikai Utsunomiya Hospital, Utsunomiya, Japan
| | - Kazuki Matsumura
- Department of Critical Care and Emergency Medicine, Tokyo Metropolitan Tama Medical Center, Tokyo, Japan
| | - Keiki Shimizu
- Department of Critical Care and Emergency Medicine, Tokyo Metropolitan Tama Medical Center, Tokyo, Japan
| | - Mitsunobu Nakamura
- Advanced Medical Emergency Department and Critical Care Center, Japan Red Cross Maebashi Hospital, Maebashi, Maebashi, UK
| | - Shingo Ichiba
- Department of Critical Care Medicine, Tokyo Women's Medical University, Tokyo, Japan
| | - Kunihiko Takahashi
- Department of Biostatistics, M&D Data Science Center, Tokyo Medical and Dental University, Tokyo, Japan
| | - Nobuaki Shime
- Department of Emergency and Critical Care Medicine, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
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8
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Kamei J, Kanamoto M, Igarashi Y, Suzuki K, Fujita K, Kuwana T, Ogura T, Mochizuki K, Banshotani Y, Ishikura H, Nakamura Y. Blood Purification in Patients with Sepsis Associated with Acute Kidney Injury: A Narrative Review. J Clin Med 2023; 12:6388. [PMID: 37835031 PMCID: PMC10573845 DOI: 10.3390/jcm12196388] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2023] [Revised: 10/01/2023] [Accepted: 10/03/2023] [Indexed: 10/15/2023] Open
Abstract
Sepsis leads to organ dysfunction. Acute kidney injury, a common type of organ dysfunction, is associated with a high mortality rate in patients with sepsis. Kidney replacement therapy can correct the metabolic, electrolyte, and fluid imbalances caused by acute kidney injury. While this therapy can improve outcomes, evidence of its beneficial effects is lacking. Herein, we review the indications for blood purification therapy, including kidney replacement therapy, and the current knowledge regarding acute kidney injury in terms of renal and non-renal indications. While renal indications have been well-documented, indications for blood purification therapy in sepsis (non-renal indications) remain controversial. Excessive inflammation is an important factor in the development of sepsis; blood purification therapy has been shown to reduce inflammatory mediators and improve hemodynamic instability. Given the pathophysiology of sepsis, blood purification therapy may decrease mortality rates in these patients. Further trials are needed in order to establish the effectiveness of blood purification therapy for sepsis.
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Affiliation(s)
- Jun Kamei
- Department of Primary Care and Emergency Medicine, Graduate School of Medicine, Kyoto University, Kyoto 606-8501, Japan;
| | - Masafumi Kanamoto
- Department of Anesthesiology, Gunma Prefectural Cardiovascular Center, 3-12, Kameizumi, Gunma 371-0004, Japan;
| | - Yutaka Igarashi
- Department of Emergency and Critical Care Medicine, Nippon Medical School, Tokyo 1138603, Japan;
| | - Kodai Suzuki
- Department of Emergency and Disaster Medicine, Gifu University Graduate School of Medicine, Gifu 501-1194, Japan;
| | - Kensuke Fujita
- Department of Emergency Medicine and Critical Care Medicine, Saiseikai Utsunomiya Hospital, Tochigi 321-0974, Japan; (K.F.); (T.O.)
| | - Tsukasa Kuwana
- Division of Emergency and Critical Care Medicine, Department of Acute Medicine, Nihon University School of Medicine, Tokyo 173-8610, Japan;
| | - Takayuki Ogura
- Department of Emergency Medicine and Critical Care Medicine, Saiseikai Utsunomiya Hospital, Tochigi 321-0974, Japan; (K.F.); (T.O.)
| | - Katsunori Mochizuki
- Department of Emergency and Critical Care Medicine, Osaka Medical and Pharmaceutical University, Osaka 569-8686, Japan;
| | - Yuki Banshotani
- Tajima Emergency & Critical Care Medical Center, Toyooka Hospital, Hyogo 668-8501, Japan;
| | - Hiroyasu Ishikura
- Department of Emergency and Critical Care Medicine, Fukuoka University Hospital, Fukuoka 814-0180, Japan;
| | - Yoshihiko Nakamura
- Department of Emergency and Critical Care Medicine, Fukuoka University Hospital, Fukuoka 814-0180, Japan;
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9
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Hikone M, Shibahashi K, Fukuda M, Shimoyama Y, Yamakawa K, Endo A, Hayakawa M, Ogura T, Hirayama A, Yasunaga H, Tagami T. Risk Factors Associated with Mortality among Mechanically Ventilated Patients with Coronavirus Disease 2019 Pneumonia: A Multicenter Cohort Study in Japan (J-RECOVER Study). Intern Med 2023; 62:2187-2194. [PMID: 37121748 PMCID: PMC10465271 DOI: 10.2169/internalmedicine.1740-23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2023] [Accepted: 03/21/2023] [Indexed: 05/02/2023] Open
Abstract
Objective Mortality analyses of patients with coronavirus disease 2019 (COVID-19) requiring invasive mechanical ventilation in Japan are limited. The present study therefore determined the risk factors for mortality in patients with COVID-19 requiring invasive mechanical ventilation. Methods This retrospective cohort study used the dataset from the Japanese multicenter research of COVID-19 by assembling real-word data (J-RECOVER) study that was conducted between January 1 and September 31, 2020. Independent risk factors associated with in-hospital mortality were evaluated using a multivariate logistic regression analysis. Kaplan-Meier estimates of the survival were calculated for different age groups. A subgroup analysis was performed to assess differences in survival rates according to additional risk factors, including an older age and chronic pulmonary disease. Patients A total of 561 patients were eligible. The median age was 67 (interquartile range: 56-75) years old, 442 (78.8%) were men, and 151 (26.9%) died in the hospital. Results Age, chronic pulmonary disease, and renal disease were significantly associated with in-hospital mortality. Compared with patients 18-54 years old, the adjusted odds ratios of patients 55-64, 65-74, and 75-94 years old were 3.34 (95% CI, 1.34-8.31), 7.07 (95% CI, 3.05-16.40), and 18.43 (95% CI, 7.94-42.78), respectively. Conclusion Age, chronic pulmonary disease, and renal disease were independently associated with mortality in patients with COVID-19 requiring invasive mechanical ventilation, and age was the most decisive indicator of a poor prognosis. Our results may aid in formulating treatment strategies and allocating healthcare resources.
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Affiliation(s)
- Mayu Hikone
- Tertiary Emergency Medical Center, Tokyo Metropolitan Bokutoh Hospital, Japan
| | - Keita Shibahashi
- Tertiary Emergency Medical Center, Tokyo Metropolitan Bokutoh Hospital, Japan
| | - Masahiro Fukuda
- Senri Critical Care Medical Center, Saiseikai Senri Hospital, Japan
| | - Yuichiro Shimoyama
- Department of Anesthesiology, Intensive Care Unit, Osaka Medical and Pharmaceutical University, Japan
| | - Kazuma Yamakawa
- Department of Emergency and Critical Care Medicine, Osaka Medical and Pharmaceutical University, Japan
| | - Akira Endo
- Trauma and Acute Critical Care Center, Tokyo Medical and Dental University Hospital, Japan
| | - Mineji Hayakawa
- Department of Emergency Medicine, Hokkaido University Hospital, Japan
| | - Takayuki Ogura
- Department of Emergency Medicine and Critical Care Medicine, Tochigi Prefectural Emergency and Critical Care Center, Imperial Gift Foundation Saiseikai, Utsunomiya Hospital, Japan
| | - Atsushi Hirayama
- Public Health, Department of Social Medicine, Graduate School of Medicine, Osaka University, Japan
| | - Hideo Yasunaga
- Department of Clinical Epidemiology and Health Economics, School of Public Health, the University of Tokyo, Japan
| | - Takashi Tagami
- Department of Emergency Medicine, Nippon Medical School Musashikosugi Hospital, Japan
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10
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Hayakawa M, Tagami T, Kudo D, Ono K, Aoki M, Endo A, Yumoto T, Matsumura Y, Irino S, Sekine K, Ushio N, Ogura T, Nachi S, Irie Y, Hayakawa K, Ito Y, Okishio Y, Muronoi T, Kosaki Y, Ito K, Nakatsutsumi K, Kondo Y, Ueda T, Fukuma H, Saisaka Y, Tominaga N, Kurita T, Nakayama F, Shibata T, Kushimoto S. The Restrictive Red Blood Cell Transfusion Strategy for Critically Injured Patients (RESTRIC) trial: a cluster-randomized, crossover, non-inferiority multicenter trial of restrictive transfusion in trauma. J Intensive Care 2023; 11:34. [PMID: 37488591 PMCID: PMC10364403 DOI: 10.1186/s40560-023-00682-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Accepted: 07/07/2023] [Indexed: 07/26/2023] Open
Abstract
BACKGROUND The efficacies of fresh frozen plasma and coagulation factor transfusion have been widely evaluated in trauma-induced coagulopathy management during the acute post-injury phase. However, the efficacy of red blood cell transfusion has not been adequately investigated in patients with severe trauma, and the optimal hemoglobin target level during the acute post-injury and resuscitation phases remains unclear. Therefore, this study aimed to examine whether a restrictive transfusion strategy was clinically non-inferior to a liberal transfusion strategy during the acute post-injury phase. METHODS This cluster-randomized, crossover, non-inferiority multicenter trial was conducted at 22 tertiary emergency medical institutions in Japan and included adult patients with severe trauma at risk of major bleeding. The institutions were allocated a restrictive or liberal transfusion strategy (target hemoglobin levels: 7-9 or 10-12 g/dL, respectively). The strategies were applied to patients immediately after arrival at the emergency department. The primary outcome was 28-day survival after arrival at the emergency department. Secondary outcomes included transfusion volume, complication rates, and event-free days. The non-inferiority margin was set at 3%. RESULTS The 28-day survival rates of patients in the restrictive (n = 216) and liberal (n = 195) strategy groups were 92.1% and 91.3%, respectively. The adjusted odds ratio for 28-day survival in the restrictive versus liberal strategy group was 1.02 (95% confidence interval: 0.49-2.13). Significant non-inferiority was not observed. Transfusion volumes and hemoglobin levels were lower in the restrictive strategy group than in the liberal strategy group. No between-group differences were noted in complication rates or event-free days. CONCLUSIONS Although non-inferiority of the restrictive versus liberal transfusion strategy for 28-day survival was not statistically significant, the mortality and complication rates were similar between the groups. The restrictive transfusion strategy results in a lower transfusion volume. TRIAL REGISTRATION NUMBER umin.ac.jp/ctr: UMIN000034405, registration date: 8 October 2018.
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Affiliation(s)
- Mineji Hayakawa
- Department of Emergency Medicine, Hokkaido University Hospital, N14W5 Kita-ku, Sapporo, 060-8648, Japan.
| | - Takashi Tagami
- Department of Emergency and Critical Care Medicine, Nippon Medical School Musashi Kosugi Hospital, Kawasaki, Japan
- Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, Tokyo, Japan
| | - Daisuke Kudo
- Division of Emergency and Critical Care Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Kota Ono
- Ono Biostat Consulting, Tokyo, Japan
| | - Makoto Aoki
- Department of Emergency Medicine, Gunma University Graduate School of Medicine, Maebashi, Japan
| | - Akira Endo
- Department of Acute Critical Care and Disaster Medicine, Tokyo Medical and Dental University Graduate School of Medicine, Tokyo, Japan
| | - Tetsuya Yumoto
- Department of Emergency, Critical Care, and Disaster Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Yosuke Matsumura
- Department of Intensive Care, Chiba Emergency Medical Centre, Chiba, Japan
| | - Shiho Irino
- Department of Emergency and Critical Care Medicine, Tokyo Saiseikai Central Hospital, Tokyo, Japan
| | - Kazuhiko Sekine
- Department of Emergency and Critical Care Medicine, Tokyo Saiseikai Central Hospital, Tokyo, Japan
| | - Noritaka Ushio
- Department of Emergency and Critical Care Medicine, Japan Red Cross Maebashi Hospital, Maebashi, Japan
| | - Takayuki Ogura
- Department of Emergency Medicine and Critical Care Medicine, Tochigi Prefectural Emergency and Critical Care Centre, Imperial Gift Foundation Saiseikai, Utsunomiya Hospital, Utsunomiya, Japan
| | - Sho Nachi
- Advanced Critical Care Centre, Gifu University Hospital, Gifu, Japan
| | - Yuhei Irie
- Department of Emergency and Critical Care Medicine, Fukuoka University Hospital, Fukuoka, Japan
| | - Katsura Hayakawa
- Advanced Emergency and Critical Care Centre, Saitama Red Cross Hospital, Saitama, Japan
| | - Yusuke Ito
- Senri Critical Care Medical Centre, Saiseikai Senri Hospital, Suita, Japan
| | - Yuko Okishio
- Department of Emergency and Critical Care Medicine, Wakayama Medical University, Wakayama, Japan
| | - Tomohiro Muronoi
- Department of Acute Care Surgery, Shimane University Faculty of Medicine, Izumo, Japan
| | - Yoshinori Kosaki
- Department of Emergency, Critical Care, and Disaster Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Kaori Ito
- Department of Surgery, Division of Acute Care Surgery, Teikyo University School of Medicine, Tokyo, Japan
| | - Keita Nakatsutsumi
- Trauma and Acute Critical Care Centre, Tokyo Medical and Dental University Hospital, Tokyo, Japan
| | - Yutaka Kondo
- Department of Emergency and Critical Care Medicine, Juntendo University Urayasu Hospital, Urayasu, Japan
| | - Taichiro Ueda
- Shock and Trauma Centre, Nippon Medical School Chiba Hokusoh Hospital, Inzai, Japan
| | - Hiroshi Fukuma
- Senshu Trauma and Critical Care Centre, Rinku General Medical Centre, Izumisano, Japan
| | - Yuichi Saisaka
- Emergency and Critical Care Centre, Kochi Health Sciences Centre, Kochi, Japan
| | - Naoki Tominaga
- Department of Emergency and Critical Care Medicine, Nippon Medical School, Tokyo, Japan
| | - Takeo Kurita
- Department of Emergency and Critical Care Medicine, Chiba University Graduate School of Medicine, Chiba, Japan
| | - Fumihiko Nakayama
- Department of Emergency and Critical Care Medicine, Nippon Medical School Tama Nagayama Hospital, Tama, Japan
| | - Tomotaka Shibata
- Advanced Trauma, Emergency and Critical Care Centre, Oita University Hospital, Yufu, Japan
| | - Shigeki Kushimoto
- Division of Emergency and Critical Care Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan
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11
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Shimoyama K, Endo A, Shimazui T, Tagami T, Yamakawa K, Hayakawa M, Ogura T, Hirayama A, Yasunaga H, Oda J. Association between obesity and mortality in critically ill COVID-19 patients requiring invasive mechanical ventilation: a multicenter retrospective observational study. Sci Rep 2023; 13:11961. [PMID: 37488189 PMCID: PMC10366113 DOI: 10.1038/s41598-023-39157-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2023] [Accepted: 07/20/2023] [Indexed: 07/26/2023] Open
Abstract
This study aimed to determine whether obesity and disease outcomes are associated in patients with critically-ill coronavirus disease 2019 (COVID-19) requiring invasive mechanical ventilation (IMV). This retrospective observational study using Japanese multicenter registry data included COVID-19 patients who required IMV and were discharged between January and September 2020. The patients were divided into the obese (body mass index [BMI] ≥ 25 kg/m2) and nonobese (BMI < 25 kg/m2) groups. Logistic regression models were used to analyze the association between obesity and disease outcomes. The primary outcome was in-hospital mortality; the secondary outcome was venovenous extracorporeal membrane oxygenation (VV-ECMO) implementation. Altogether, 477 patients were enrolled (obese, n = 235, median BMI, 28.2 kg/m2; nonobese, n = 242, median BMI, 22.4 kg/m2). Obesity was significantly associated with lower in-hospital mortality in the unadjusted logistic regression model (odds ratio 0.63; 95% confidence interval, 0.42-0.97; p = 0.033), but not with mortality in the adjusted logistic regression model using age, sex, and Charlson Comorbidity Index as covariates (p = 0.564). Obesity was not associated with VV-ECMO implementation in both unadjusted and adjusted models (unadjusted, p = 0.074; adjusted, p = 0.695). Obesity was not associated with outcomes in COVID-19 patients requiring IMV. Obesity may not be a risk factor for poor outcomes in these patients.
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Affiliation(s)
- Keiichiro Shimoyama
- Department of Emergency and Critical Care Medicine, Tokyo Medical University Hospital, 6-7-1, Nisi-Shinjuku, Shinjuku-ku, Tokyo, 160-0023, Japan.
| | - Akira Endo
- Trauma and Acute Critical Care Center, Tokyo Medical and Dental University Hospital, 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8519, Japan
- Department of Acute Critical Care Medicine, Tsuchiura Kyodo General Hospital, 4-1-1, Otsuno, Tsuchiura, Ibaraki, 300-0028, Japan
| | - Takashi Shimazui
- Department of Emergency and Critical Care Medicine, Kimitsu Chuo Hospital, 1010 Sakurai, Kisarazu, Chiba, 292-8535, Japan
| | - Takashi Tagami
- Department of Emergency and Critical Care Medicine, Nippon Medical School Musashikosugi Hospital, 1-383 Kosugimachi, Nakahara-ku, Kawasaki, Kanagawa, 211-8533, Japan
| | - Kazuma Yamakawa
- Department of Emergency Medicine, Osaka Medical and Pharmaceutical University, 2-7 Daigakumachi, Takatsuki, Osaka, 569-8686, Japan
| | - Mineji Hayakawa
- Department of Emergency Medicine, Hokkaido University Hospital, N14W5, Kita-ku, Sapporo, 060-8648, Japan
| | - Takayuki Ogura
- Department of Emergency Medicine and Critical Care Medicine, Tochigi Prefectural Emergency and Critical Care Center, Imperial Gift Foundation SAISEIKAI, Utsunomiya Hospital, 911-1 Takebayashi-machi, Utsunomiya, Tochigi, 321-0974, Japan
| | - Atsushi Hirayama
- Public Health, Department of Social Medicine, Graduate School of Medicine, Osaka University, 2-15, Yamadaoka, Suita, Osaka, 565-0871, Japan
| | - Hideo Yasunaga
- Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, 7-3-1 Hong, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Jun Oda
- Department of Traumatology and Acute Critical Medicine, Graduate School of Medicine, Osaka University, 2-15, Yamadaoka, Suita, Osaka, 565-0871, Japan
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12
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Yamamoto S, Yamayoshi S, Ito M, Sakai-Tagawa Y, Nakachi I, Baba R, Kamimoto S, Ogura T, Hagiwara S, Kato H, Nakajima H, Uwamino Y, Yagi K, Sugaya N, Nagai H, Saito M, Adachi E, Koga M, Tsutsumi T, Duong C, Okuda M, Murakami J, Furusawa Y, Ujie M, Iwatsuki-Horimoto K, Yotsuyanagi H, Kawaoka Y. Differences among epitopes recognized by neutralizing antibodies induced by SARS-CoV-2 infection or COVID-19 vaccination. iScience 2023; 26:107208. [PMID: 37448563 PMCID: PMC10290734 DOI: 10.1016/j.isci.2023.107208] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Revised: 04/21/2023] [Accepted: 06/21/2023] [Indexed: 07/15/2023] Open
Abstract
SARS-CoV-2 has gradually acquired amino acid substitutions in its S protein that reduce the potency of neutralizing antibodies, leading to decreased vaccine efficacy. Here, we attempted to obtain mutant viruses by passaging SARS-CoV-2 in the presence of plasma samples from convalescent patients or vaccinees to determine which amino acid substitutions affect the antigenicity of SARS-CoV-2. Several amino acid substitutions in the S2 region, as well as the N-terminal domain (NTD) and receptor-binding domain (RBD), affected the neutralization potency of plasma samples collected from vaccinees, indicating that amino acid substitutions in the S2 region as well as those in the NTD and RBD affect neutralization by vaccine-induced antibodies. Furthermore, the neutralizing potency of vaccinee plasma samples against mutant viruses we obtained or circulating viruses differed among individuals. These findings suggest that genetic backgrounds of vaccinees influence the recognition of neutralizing epitopes.
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Affiliation(s)
- Shinya Yamamoto
- Division of Virology, Institute of Medical Science, University of Tokyo, Tokyo 108-8639, Japan
- Division of Infectious Diseases, Advanced Clinical Research Center, Institute of Medical Science, University of Tokyo, Tokyo 108-8639, Japan
| | - Seiya Yamayoshi
- Division of Virology, Institute of Medical Science, University of Tokyo, Tokyo 108-8639, Japan
- The Research Center for Global Viral Diseases, National Center for Global Health and Medicine Research Institute, Tokyo 162-8655, Japan
| | - Mutsumi Ito
- Division of Virology, Institute of Medical Science, University of Tokyo, Tokyo 108-8639, Japan
| | - Yuko Sakai-Tagawa
- Division of Virology, Institute of Medical Science, University of Tokyo, Tokyo 108-8639, Japan
| | - Ichiro Nakachi
- Pulmonary Division, Department of Internal Medicine, Saiseikai Utsunomiya Hospital, Tochigi 321-0974, Japan
| | - Rie Baba
- Pulmonary Division, Department of Internal Medicine, Saiseikai Utsunomiya Hospital, Tochigi 321-0974, Japan
| | - Shigenobu Kamimoto
- Pulmonary Division, Department of Internal Medicine, Saiseikai Utsunomiya Hospital, Tochigi 321-0974, Japan
| | - Takayuki Ogura
- Department of Emergency and Intensive Care, Saiseikai Utsunomiya Hospital, Tochigi 321-0974, Japan
| | - Shigehiro Hagiwara
- Department of Clinical Laboratory, Saiseikai Utsunomiya Hospital, Tochigi 321-0974, Japan
| | - Hideaki Kato
- Department of Hematology and Clinical Immunology, Yokohama City University School of Medicine, Kanagawa 236-0004, Japan
| | - Hideaki Nakajima
- Department of Hematology and Clinical Immunology, Yokohama City University School of Medicine, Kanagawa 236-0004, Japan
| | - Yoshifumi Uwamino
- Department of Laboratory Medicine, Keio University School of Medicine, Tokyo 160-8582, Japan
| | - Kazuma Yagi
- Department of Pulmonary Medicine, Keiyu Hospital, Kanagawa 220-8521, Japan
| | - Norio Sugaya
- Department of Pediatrics, Keiyu Hospital, Kanagawa 220-8521, Japan
| | - Hiroyuki Nagai
- Department of Infectious Diseases and Applied Immunology, IMSUT Hospital of The Institute of Medical Science, University of Tokyo, Tokyo 108-8639, Japan
| | - Makoto Saito
- Division of Infectious Diseases, Advanced Clinical Research Center, Institute of Medical Science, University of Tokyo, Tokyo 108-8639, Japan
- Department of Infectious Diseases and Applied Immunology, IMSUT Hospital of The Institute of Medical Science, University of Tokyo, Tokyo 108-8639, Japan
| | - Eisuke Adachi
- Division of Infectious Diseases, Advanced Clinical Research Center, Institute of Medical Science, University of Tokyo, Tokyo 108-8639, Japan
- Department of Infectious Diseases and Applied Immunology, IMSUT Hospital of The Institute of Medical Science, University of Tokyo, Tokyo 108-8639, Japan
| | - Michiko Koga
- Division of Infectious Diseases, Advanced Clinical Research Center, Institute of Medical Science, University of Tokyo, Tokyo 108-8639, Japan
- Department of Infectious Diseases and Applied Immunology, IMSUT Hospital of The Institute of Medical Science, University of Tokyo, Tokyo 108-8639, Japan
| | - Takeya Tsutsumi
- Division of Infectious Diseases, Advanced Clinical Research Center, Institute of Medical Science, University of Tokyo, Tokyo 108-8639, Japan
- Department of Infectious Diseases and Applied Immunology, IMSUT Hospital of The Institute of Medical Science, University of Tokyo, Tokyo 108-8639, Japan
| | - Calvin Duong
- Division of Virology, Institute of Medical Science, University of Tokyo, Tokyo 108-8639, Japan
| | - Moe Okuda
- Division of Virology, Institute of Medical Science, University of Tokyo, Tokyo 108-8639, Japan
| | - Jurika Murakami
- Division of Virology, Institute of Medical Science, University of Tokyo, Tokyo 108-8639, Japan
| | - Yuri Furusawa
- Division of Virology, Institute of Medical Science, University of Tokyo, Tokyo 108-8639, Japan
| | - Michiko Ujie
- Division of Virology, Institute of Medical Science, University of Tokyo, Tokyo 108-8639, Japan
| | | | - Hiroshi Yotsuyanagi
- Division of Infectious Diseases, Advanced Clinical Research Center, Institute of Medical Science, University of Tokyo, Tokyo 108-8639, Japan
- Department of Infectious Diseases and Applied Immunology, IMSUT Hospital of The Institute of Medical Science, University of Tokyo, Tokyo 108-8639, Japan
| | - Yoshihiro Kawaoka
- Division of Virology, Institute of Medical Science, University of Tokyo, Tokyo 108-8639, Japan
- The Research Center for Global Viral Diseases, National Center for Global Health and Medicine Research Institute, Tokyo 162-8655, Japan
- Influenza Research Institute, Department of Pathobiological Sciences, School of Veterinary Medicine, University of Wisconsin-Madison, Madison, WI 53711, USA
- The University of Tokyo, Pandemic Preparedness, Infection and Advanced Research Center, Tokyo 108-8639, Japan
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13
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Amagasa S, Uematsu S, Kubota M, Kashiura M, Yasuda H, Hayakawa M, Yamakawa K, Endo A, Ogura T, Hirayama A, Yasunaga H, Tagami T. Relationship between institutional ventilated COVID-19 case volume and in-hospital death: A multicenter cohort study. PLoS One 2023; 18:e0287310. [PMID: 37319278 PMCID: PMC10270613 DOI: 10.1371/journal.pone.0287310] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2022] [Accepted: 06/03/2023] [Indexed: 06/17/2023] Open
Abstract
BACKGROUND The volume-outcome relationship in patients with severe Coronavirus disease 2019 (COVID-19) is unclear and is important for establishing a system for the medical care of severe COVID-19. This study aimed to evaluate the association between institutional case volume and outcomes in patients with ventilated COVID-19. METHODS We analyzed patients with severe COVID-19 on ventilatory control aged > 17 years who were enrolled in the J-RECOVER study, which is a retrospective multicenter observational study conducted between January 2020 and September 2020 in Japan. Based on the ventilated COVID-19 case volume, the higher one-third of institutions were defined as high-volume centers, the middle one-third as middle-volume centers, and the lower one-third as low-volume centers. The primary outcome measure was in-hospital mortality during hospitalization due to COVID-19. Multivariate logistic regression analysis for in-hospital mortality and ventilated COVID-19 case volume was performed after adjusting for multiple propensity scores and in-hospital variables. To estimate the multiple propensity score, we fitted a multinomial logistic regression model, which fell into one of the three groups based on patient demographics and prehospital factors. RESULTS We analyzed 561 patients who required ventilator management. In total, 159, 210, and 192 patients were admitted to low-volume (36 institutions, < 11 severe COVID-19 cases per institution during the study period), middle-volume (14 institutions, 11-25 severe cases per institution), and high-volume (5 institutions, > 25 severe cases per institution) centers, respectively. After adjustment for multiple propensity scores and in-hospital variables, admission to middle- and high-volume centers was not significantly associated with in-hospital death compared with admission to low-volume centers (adjusted odds ratio, 0.77 [95% confidence interval (CI): 0.46-1.29] and adjusted odds ratio, 0.76 [95% CI: 0.44-1.33], respectively). CONCLUSIONS There may be no significant relationship between institutional case volume and in-hospital mortality in patients with ventilated COVID-19.
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Affiliation(s)
- Shunsuke Amagasa
- Division of Emergency and Transport Services, National center for Child Health and Development, Okura, Setagaya-ku, Tokyo, Japan
| | - Satoko Uematsu
- Department of Interdisciplinary Medicine, Division of General Pediatrics, National Center for Child Health and Development, Okura, Setagaya-ku, Tokyo, Japan
| | - Mitsuru Kubota
- Department of Interdisciplinary Medicine, Division of General Pediatrics, National Center for Child Health and Development, Okura, Setagaya-ku, Tokyo, Japan
| | - Masahiro Kashiura
- Department of Emergency and Critical Care Medicine, Saitama Medical Center, Jichi Medical University, Amanuma-cho, Omiya-ku, Saitama City, Saitama, Japan
| | - Hideto Yasuda
- Department of Emergency and Critical Care Medicine, Saitama Medical Center, Jichi Medical University, Amanuma-cho, Omiya-ku, Saitama City, Saitama, Japan
| | - Mineji Hayakawa
- Department of Emergency Medicine, Hokkaido University Hospital, Kita-ku, Sapporo, Japan
| | - Kazuma Yamakawa
- Department of Emergency Medicine, Osaka Medical and Pharmaceutical University, Daigakumachi, Takatsuki, Osaka, Japan
| | - Akira Endo
- Trauma and Acute Critical Care Center, Tokyo Medical and Dental University Hospital, Yushima, Bunkyo-ku, Tokyo, Japan
| | - Takayuki Ogura
- Department of Emergency Medicine and Critical Care Medicine, Tochigi Prefectural Emergency and Critical Care Centre, Imperial Foundation Saiseikai Utsunomiya Hospital, Takebayashi-machi, Utsunomiya, Tochigi, Japan
| | - Atsushi Hirayama
- Department of Social Medicine, Public Health, Graduate School of Medicine, Osaka University, Yamadaoka, Suita, Japan
| | - Hideo Yasunaga
- Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, Hongo, Bunkyo-ku, Tokyo, Japan
| | - Takashi Tagami
- Department of Emergency and Critical Care Medicine, Nippon Medical School Musashikosugi Hospital, Kosugimachi, Nakahara-ku, Kawasaki, Kanagawa, Japan
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Nishikimi M, Ohshimo S, Fukumoto W, Anzai T, Awai K, Ogura T, Abe T, Masuda M, Fujizuka K, Nakamura M, Kyo M, Takahashi K, Shime N. Characteristics of the pulmonary opacities on chest CT associated with difficulty in short-term liberation from veno-venous ECMO in patients with severe ARDS. Respir Res 2023; 24:128. [PMID: 37165334 PMCID: PMC10171155 DOI: 10.1186/s12931-023-02425-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Accepted: 04/17/2023] [Indexed: 05/12/2023] Open
Abstract
BACKGROUND It is clinically important to predict difficulty in short-term liberation from veno-venous extracorporeal membrane oxygenation (V-V ECMO) in patients with severe acute respiratory distress syndrome (ARDS) at the time of initiation of the support. The aim of this study was to identify the characteristics of pulmonary opacities on chest CT that is associated with difficulty in short-term liberation from V-V ECMO (< 14 days). METHODS This multicenter retrospective study was conducted in adult patients initiated on V-V ECMO for severe ARDS between January 2014 and June 2022. The pulmonary opacities on CT at the time of initiation of the ECMO support were evaluated in a blinded manner, focusing on the following three characteristics of the opacities: (1) their distribution (focal/diffuse on the dorso-ventral axis or unilateral/bilateral on the left-right axis); (2) their intensity (pure ground glass/pure consolidation/mixed pattern); and (3) the degree of fibroproliferation (signs of traction bronchiectasis or reticular opacities). RESULTS Among the 153 patients, 72 (47%) were successfully liberated from ECMO in the short term, while short-term liberation failed in the remaining 81 (53%) patients. Multivariate logistic regression analysis showed that the presence of mixed-pattern pulmonary opacities and signs of traction bronchiectasis, but not the distribution of the opacities, were independently associated with difficulty in short-term liberation (OR [95% CI]; 4.8 [1.4-16.5] and 3.9 [1.4-11.2], respectively). CONCLUSIONS The presence of a mixed pattern of the pulmonary opacities and signs of traction bronchiectasis on the chest CT were independently associated with difficulty in short-term liberation from V-V ECMO in severe ARDS patients.
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Affiliation(s)
- Mitsuaki Nishikimi
- Department of Emergency and Critical Care Medicine, Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima, 734-8551, Japan
- Department of Emergency and Critical Care Medicine, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Shinichiro Ohshimo
- Department of Emergency and Critical Care Medicine, Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima, 734-8551, Japan.
| | - Wataru Fukumoto
- Department of Diagnostic Radiology, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Tatsuhiko Anzai
- Department of Biostatistics, M&D Data Science Center, Tokyo Medical and Dental University, Tokyo, Japan
| | - Kazuo Awai
- Department of Diagnostic Radiology, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Takayuki Ogura
- Department of Emergency Medicine and Critical Care Medicine, SAISEIKAI Utsunomiya Hospital, Utsunomiya, Japan
| | - Toshikazu Abe
- Department of Emergency and Critical Care Medicine, Tsukuba Memorial Hospital, Tsukuba, Japan
- Department of Health Services Research, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Mamoru Masuda
- Advanced Medical Emergency Department and Critical Care Center, Japan Red Cross Maebashi Hospital, Maebashi, Japan
| | - Kenji Fujizuka
- Advanced Medical Emergency Department and Critical Care Center, Japan Red Cross Maebashi Hospital, Maebashi, Japan
| | - Mitsunobu Nakamura
- Advanced Medical Emergency Department and Critical Care Center, Japan Red Cross Maebashi Hospital, Maebashi, Japan
| | - Michihito Kyo
- Department of Emergency and Critical Care Medicine, Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima, 734-8551, Japan
| | - Kunihiko Takahashi
- Department of Biostatistics, M&D Data Science Center, Tokyo Medical and Dental University, Tokyo, Japan
| | - Nobuaki Shime
- Department of Emergency and Critical Care Medicine, Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima, 734-8551, Japan
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15
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Takenaka M, Hayashi K, Yamada G, Ogura T, Ito M, Milner AM, Tojo K. Behavior of snow monkeys hunting fish to survive winter. Sci Rep 2022; 12:20324. [PMID: 36446833 PMCID: PMC9709167 DOI: 10.1038/s41598-022-23799-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Accepted: 11/05/2022] [Indexed: 11/30/2022] Open
Abstract
Japanese macaques, Macaca fuscata, of Kamikochi in the Japanese Alps endure one of the coldest and harshest environments during winter when scarcity of food puts them at risk. However, various behaviors have evolved to mitigate potential mortality. These macaques typically eat bamboo leaves and the bark of woody plants in winter, but our previous study using the feces of Japanese macaques collected in the winter and DNA metabarcoding analysis revealed conclusively for the first time consumption of riverine benthos and brown trout. In this paper, we investigate how Japanese macaques hunt fish and collect these riverine biota by extensively observing their behavior, including the use of infrared sensor cameras. Many researchers have tracked Japanese macaques as part of behavioral and ecological studies, but previously the techniques by which Japanese macaques capture swimming fish has not been documented. Herein, for the first time we consider how novel macaque foraging behavior traits have evolved to secure valuable animal protein for winter survival when food resources are scarce.
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Affiliation(s)
- Masaki Takenaka
- grid.263518.b0000 0001 1507 4692Department of Biology, Faculty of Science, Shinshu University, Asahi 3-1-1, Matsumoto, 390-8621 Japan ,grid.263518.b0000 0001 1507 4692Institute of Mountain Science, Shinshu University, Asahi 3-1-1, Matsumoto, Nagano 390-8621 Japan ,grid.20515.330000 0001 2369 4728Sugadaira Research Station, Mountain Science Center, University of Tsukuba, Sugadairakougen 1278-294, Ueda, Nagano 386-2204 Japan
| | - Kosuke Hayashi
- grid.472641.20000 0001 2146 3010NHK Enterprises, Inc., Kamiyama 4-14, Shibuya, Tokyo, 150-0047 Japan
| | - Genki Yamada
- G-Vision, Inc., Nishitsutsujigaoka 1-54-12, Chofu, Tokyo 182-0006 Japan
| | - Takayuki Ogura
- Kozo Production, Kamiyama 16-4-2B, Shibuya, Tokyo, 150-0047 Japan
| | - Mone Ito
- Kozo Production, Kamiyama 16-4-2B, Shibuya, Tokyo, 150-0047 Japan
| | - Alexander M. Milner
- grid.263518.b0000 0001 1507 4692Institute of Mountain Science, Shinshu University, Asahi 3-1-1, Matsumoto, Nagano 390-8621 Japan ,grid.6572.60000 0004 1936 7486School of Geography, Earth and Environmental Science, University of Birmingham, Birmingham, UK
| | - Koji Tojo
- grid.263518.b0000 0001 1507 4692Department of Biology, Faculty of Science, Shinshu University, Asahi 3-1-1, Matsumoto, 390-8621 Japan ,grid.263518.b0000 0001 1507 4692Institute of Mountain Science, Shinshu University, Asahi 3-1-1, Matsumoto, Nagano 390-8621 Japan
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Ohshimo S, Liu K, Ogura T, Iwashita Y, Kushimoto S, Shime N, Hashimoto S, Fujino Y, Takeda S. Trends in survival during the pandemic in patients with critical COVID-19 receiving mechanical ventilation with or without ECMO: analysis of the Japanese national registry data. Crit Care 2022; 26:354. [PMCID: PMC9664428 DOI: 10.1186/s13054-022-04187-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2022] [Accepted: 10/04/2022] [Indexed: 11/16/2022] Open
Abstract
Abstract
Background
The survival rate of patients with critical coronavirus disease-19 (COVID-19) over time is inconsistent in different settings. In Japan, a national database was organized to monitor and share the patient generation across the country in an immediate response to the COVID-19 pandemic. This study aimed to evaluate changes in survival over time and the prognostic factors in critical COVID-19 patients receiving mechanical ventilation with/without extracorporeal membrane oxygenation (ECMO) using the largest database in Japan.
Methods
This is a prospective observational cohort study of patients admitted to intensive care units in Japan with fatal COVID-19 pneumonia receiving mechanical ventilation and/or ECMO. We developed a prospective nationwide registry covering > 80% of intensive care units in Japan, and analyzed the association between patients’ backgrounds, institutional ECMO experience, and timing of treatment initiation and prognosis between February 2020 and November 2021. Prognostic factors were evaluated by Kaplan–Meier analysis and Cox proportional hazards analysis.
Results
A total of 9418 patients were ventilated, of whom 1214 (13%) received ECMO. The overall survival rate for ventilated patients was 79%, 65% for those receiving ECMO. There have been five outbreaks in Japan to date. The survival rate of ventilated patients increased from 76% in the first outbreak to 84% in the fifth outbreak (p < 0.001). The survival rate of ECMO patients remained unchanged at 60–68% from the first to fifth outbreaks (p = 0.084). Age of ≥ 59 (hazard ratio [HR] 2.17; 95% confidence interval [CI] 1.76–2.68), ventilator days of ≥ 3 before starting ECMO (HR 1.91; 95% CI 1.57–2.32), and institutional ECMO experiences of ≥ 11 (HR 0.70; 95% CI 0.58–0.85) were independent prognostic factors for ECMO.
Conclusions
During five COVID-19 outbreaks in Japan, the survival rate of ventilated patients tended to have gradually improved, and that of ECMO patients did not deteriorate. Older age, longer ventilator days before starting ECMO, and fewer institutional ECMO experiences may be independent prognostic factors for critical COVID-19 patients receiving ECMO.
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Misumi K, Hagiwara Y, Ogura T. Giant cylinder-shaped venous thrombus caused by extracorporeal membrane oxygenation cannula. Acute Med Surg 2022; 9:e791. [PMID: 36254311 PMCID: PMC9526802 DOI: 10.1002/ams2.791] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2022] [Accepted: 09/08/2022] [Indexed: 11/08/2022] Open
Affiliation(s)
- Kayo Misumi
- Department of Emergency and Critical CareSaiseikai Utsunomiya HospitalUtsunomiyaJapan,Department of CardiologySaiseikai Utsunomiya HospitalUtsunomiyaJapan
| | - Yoshihiro Hagiwara
- Department of Emergency and Critical CareSaiseikai Utsunomiya HospitalUtsunomiyaJapan
| | - Takayuki Ogura
- Department of Emergency and Critical CareSaiseikai Utsunomiya HospitalUtsunomiyaJapan
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18
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Takai C, Misumi K, Kaito D, Nishida H, Yoshii M, Yamada S, Kobayashi T, Koinuma T, Kadoya T, Kimura T, Hagiwara Y, Ogura T. Lacosamide Intoxication-induced Wide QRS Tachycardia Successfully Treated with Veno-arterial Extracorporeal Membrane Oxygenation. Intern Med 2022; 62:1185-1189. [PMID: 36104195 PMCID: PMC10183285 DOI: 10.2169/internalmedicine.0145-22] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Lacosamide is an antiepileptic drug that acts on voltage-gated sodium channels and was approved as an antiepileptic by the Food and Drug Administration in 2008. Although the efficacy and safety of lacosamide have been established in many previous trials, some case reports have shown that it may lead to cardiovascular side effects, especially in patients with electrical conduction system disorders. We herein report a case of life-threatening cardiac arrhythmia caused by lacosamide intoxication that was successfully treated with veno-arterial extracorporeal membrane oxygenation.
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Affiliation(s)
- Chihiro Takai
- Department of Emergency and Critical Care, Saiseikai Utsunomiya Hospital, Japan
| | - Kayo Misumi
- Department of Emergency and Critical Care, Saiseikai Utsunomiya Hospital, Japan
- Department of Cardiology, Saiseikai Utsunomiya Hospital, Japan
| | - Daiki Kaito
- Department of Emergency and Critical Care, Saiseikai Utsunomiya Hospital, Japan
| | - Hiroaki Nishida
- Department of Cardiology, Saiseikai Utsunomiya Hospital, Japan
| | - Masami Yoshii
- Department of Neurology, Saiseikai Utsunomiya Hospital, Japan
| | - So Yamada
- Department of Emergency and Critical Care, Saiseikai Utsunomiya Hospital, Japan
| | - Takaomi Kobayashi
- Department of Emergency and Critical Care, Saiseikai Utsunomiya Hospital, Japan
| | - Toshitaka Koinuma
- Department of Emergency and Critical Care, Saiseikai Utsunomiya Hospital, Japan
| | - Takashi Kadoya
- Department of Emergency and Critical Care, Saiseikai Utsunomiya Hospital, Japan
| | - Takuya Kimura
- Department of Emergency and Critical Care, Saiseikai Utsunomiya Hospital, Japan
| | - Yoshihiro Hagiwara
- Department of Emergency and Critical Care, Saiseikai Utsunomiya Hospital, Japan
| | - Takayuki Ogura
- Department of Emergency and Critical Care, Saiseikai Utsunomiya Hospital, Japan
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Fujita M, Maeda T, Miyata S, Mizugaki A, Hayakawa M, Miyagawa N, Ushio N, Shiraishi A, Ogura T, Irino S, Sekine K, Fujinami Y, Kiridume K, Hifumi T, Kushimoto S. Association of trauma severity with antibody seroconversion in heparin-induced thrombocytopenia: A multicenter, prospective, observational study. J Trauma Acute Care Surg 2022; 93:402-408. [PMID: 35271548 PMCID: PMC9398508 DOI: 10.1097/ta.0000000000003603] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2021] [Revised: 02/12/2022] [Accepted: 02/27/2022] [Indexed: 11/25/2022]
Abstract
BACKGROUND Heparin administration can induce the production of anti-platelet factor 4 (PF4)/heparin antibodies with platelet-activating properties, causing heparin-induced thrombocytopenia (HIT). Previous studies have suggested that trauma severity influences HIT immune responses, but their relationship has not been fully explained. This study aimed to clarify this association by multicenter prospective observational study. METHODS Trauma patients who met the criteria of age 18 years or older and Injury Severity Scores (ISSs) of ≥9 from March 2018 to February 2019 were included. Patients who did not receive any heparin and those who received it as flushes or for treatment were also included. Patients were divided into three groups based on trauma severity (to mild [ISS 9-15], moderate [ISS 16-24], and severe injury groups [ISS ≥25]) and were compared by the seroconversion time and rate, as well as the disappearance rate of antibodies on day 30. RESULTS A total of 184 patients were included: 55, 62, and 67 patients were classified into the mild, moderate, and severe injury groups, respectively. Overall, the seroconversion rates of anti-PF4/heparin immunoglobulin G (IgG) and HIT antibodies by washed platelet activation assay were 26.6% and 16.3%, respectively. There was a significant difference in the seroconversion rates of anti-PF4/heparin IgG ( p = 0.016) and HIT antibodies ( p = 0.046) among the groups. Seroconversion rates in both assays increased with increasing trauma severity. The time required to achieve seroconversion was similar (between 5 and 10 days of trauma onset) regardless of heparin administration. Anti-PF4/heparin IgG and HIT antibodies were no longer detected on day 30 in 28.6% and 60.9% of seroconverted patients, respectively. CONCLUSION Development of HIT antibodies was observed commonly in severely injured trauma patients. Heparin-induced thrombocytopenia antibody development may be related to trauma severity, with a high disappearance frequency on day 30. LEVEL OF EVIDENCE Therapeutic/Care Management; Level III.
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20
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Wang QS, Edahiro R, Namkoong H, Hasegawa T, Shirai Y, Sonehara K, Tanaka H, Lee H, Saiki R, Hyugaji T, Shimizu E, Katayama K, Kanai M, Naito T, Sasa N, Yamamoto K, Kato Y, Morita T, Takahashi K, Harada N, Naito T, Hiki M, Matsushita Y, Takagi H, Ichikawa M, Nakamura A, Harada S, Sandhu Y, Kabata H, Masaki K, Kamata H, Ikemura S, Chubachi S, Okamori S, Terai H, Morita A, Asakura T, Sasaki J, Morisaki H, Uwamino Y, Nanki K, Uchida S, Uno S, Nishimura T, Ishiguro T, Isono T, Shibata S, Matsui Y, Hosoda C, Takano K, Nishida T, Kobayashi Y, Takaku Y, Takayanagi N, Ueda S, Tada A, Miyawaki M, Yamamoto M, Yoshida E, Hayashi R, Nagasaka T, Arai S, Kaneko Y, Sasaki K, Tagaya E, Kawana M, Arimura K, Takahashi K, Anzai T, Ito S, Endo A, Uchimura Y, Miyazaki Y, Honda T, Tateishi T, Tohda S, Ichimura N, Sonobe K, Sassa CT, Nakajima J, Nakano Y, Nakajima Y, Anan R, Arai R, Kurihara Y, Harada Y, Nishio K, Ueda T, Azuma M, Saito R, Sado T, Miyazaki Y, Sato R, Haruta Y, Nagasaki T, Yasui Y, Hasegawa Y, Mutoh Y, Kimura T, Sato T, Takei R, Hagimoto S, Noguchi Y, Yamano Y, Sasano H, Ota S, Nakamori Y, Yoshiya K, Saito F, Yoshihara T, Wada D, Iwamura H, Kanayama S, Maruyama S, Yoshiyama T, Ohta K, Kokuto H, Ogata H, Tanaka Y, Arakawa K, Shimoda M, Osawa T, Tateno H, Hase I, Yoshida S, Suzuki S, Kawada M, Horinouchi H, Saito F, Mitamura K, Hagihara M, Ochi J, Uchida T, Baba R, Arai D, Ogura T, Takahashi H, Hagiwara S, Nagao G, Konishi S, Nakachi I, Murakami K, Yamada M, Sugiura H, Sano H, Matsumoto S, Kimura N, Ono Y, Baba H, Suzuki Y, Nakayama S, Masuzawa K, Namba S, Shiroyama T, Noda Y, Niitsu T, Adachi Y, Enomoto T, Amiya S, Hara R, Yamaguchi Y, Murakami T, Kuge T, Matsumoto K, Yamamoto Y, Yamamoto M, Yoneda M, Tomono K, Kato K, Hirata H, Takeda Y, Koh H, Manabe T, Funatsu Y, Ito F, Fukui T, Shinozuka K, Kohashi S, Miyazaki M, Shoko T, Kojima M, Adachi T, Ishikawa M, Takahashi K, Inoue T, Hirano T, Kobayashi K, Takaoka H, Watanabe K, Miyazawa N, Kimura Y, Sado R, Sugimoto H, Kamiya A, Kuwahara N, Fujiwara A, Matsunaga T, Sato Y, Okada T, Hirai Y, Kawashima H, Narita A, Niwa K, Sekikawa Y, Nishi K, Nishitsuji M, Tani M, Suzuki J, Nakatsumi H, Ogura T, Kitamura H, Hagiwara E, Murohashi K, Okabayashi H, Mochimaru T, Nukaga S, Satomi R, Oyamada Y, Mori N, Baba T, Fukui Y, Odate M, Mashimo S, Makino Y, Yagi K, Hashiguchi M, Kagyo J, Shiomi T, Fuke S, Saito H, Tsuchida T, Fujitani S, Takita M, Morikawa D, Yoshida T, Izumo T, Inomata M, Kuse N, Awano N, Tone M, Ito A, Nakamura Y, Hoshino K, Maruyama J, Ishikura H, Takata T, Odani T, Amishima M, Hattori T, Shichinohe Y, Kagaya T, Kita T, Ohta K, Sakagami S, Koshida K, Hayashi K, Shimizu T, Kozu Y, Hiranuma H, Gon Y, Izumi N, Nagata K, Ueda K, Taki R, Hanada S, Kawamura K, Ichikado K, Nishiyama K, Muranaka H, Nakamura K, Hashimoto N, Wakahara K, Koji S, Omote N, Ando A, Kodama N, Kaneyama Y, Maeda S, Kuraki T, Matsumoto T, Yokote K, Nakada TA, Abe R, Oshima T, Shimada T, Harada M, Takahashi T, Ono H, Sakurai T, Shibusawa T, Kimizuka Y, Kawana A, Sano T, Watanabe C, Suematsu R, Sageshima H, Yoshifuji A, Ito K, Takahashi S, Ishioka K, Nakamura M, Masuda M, Wakabayashi A, Watanabe H, Ueda S, Nishikawa M, Chihara Y, Takeuchi M, Onoi K, Shinozuka J, Sueyoshi A, Nagasaki Y, Okamoto M, Ishihara S, Shimo M, Tokunaga Y, Kusaka Y, Ohba T, Isogai S, Ogawa A, Inoue T, Fukuyama S, Eriguchi Y, Yonekawa A, Kan-o K, Matsumoto K, Kanaoka K, Ihara S, Komuta K, Inoue Y, Chiba S, Yamagata K, Hiramatsu Y, Kai H, Asano K, Oguma T, Ito Y, Hashimoto S, Yamasaki M, Kasamatsu Y, Komase Y, Hida N, Tsuburai T, Oyama B, Takada M, Kanda H, Kitagawa Y, Fukuta T, Miyake T, Yoshida S, Ogura S, Abe S, Kono Y, Togashi Y, Takoi H, Kikuchi R, Ogawa S, Ogata T, Ishihara S, Kanehiro A, Ozaki S, Fuchimoto Y, Wada S, Fujimoto N, Nishiyama K, Terashima M, Beppu S, Yoshida K, Narumoto O, Nagai H, Ooshima N, Motegi M, Umeda A, Miyagawa K, Shimada H, Endo M, Ohira Y, Watanabe M, Inoue S, Igarashi A, Sato M, Sagara H, Tanaka A, Ohta S, Kimura T, Shibata Y, Tanino Y, Nikaido T, Minemura H, Sato Y, Yamada Y, Hashino T, Shinoki M, Iwagoe H, Takahashi H, Fujii K, Kishi H, Kanai M, Imamura T, Yamashita T, Yatomi M, Maeno T, Hayashi S, Takahashi M, Kuramochi M, Kamimaki I, Tominaga Y, Ishii T, Utsugi M, Ono A, Tanaka T, Kashiwada T, Fujita K, Saito Y, Seike M, Watanabe H, Matsuse H, Kodaka N, Nakano C, Oshio T, Hirouchi T, Makino S, Egi M, Omae Y, Nannya Y, Ueno T, Takano T, Katayama K, Ai M, Kumanogoh A, Sato T, Hasegawa N, Tokunaga K, Ishii M, Koike R, Kitagawa Y, Kimura A, Imoto S, Miyano S, Ogawa S, Kanai T, Fukunaga K, Okada Y. The whole blood transcriptional regulation landscape in 465 COVID-19 infected samples from Japan COVID-19 Task Force. Nat Commun 2022; 13:4830. [PMID: 35995775 PMCID: PMC9395416 DOI: 10.1038/s41467-022-32276-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Accepted: 07/25/2022] [Indexed: 11/12/2022] Open
Abstract
Coronavirus disease 2019 (COVID-19) is a recently-emerged infectious disease that has caused millions of deaths, where comprehensive understanding of disease mechanisms is still unestablished. In particular, studies of gene expression dynamics and regulation landscape in COVID-19 infected individuals are limited. Here, we report on a thorough analysis of whole blood RNA-seq data from 465 genotyped samples from the Japan COVID-19 Task Force, including 359 severe and 106 non-severe COVID-19 cases. We discover 1169 putative causal expression quantitative trait loci (eQTLs) including 34 possible colocalizations with biobank fine-mapping results of hematopoietic traits in a Japanese population, 1549 putative causal splice QTLs (sQTLs; e.g. two independent sQTLs at TOR1AIP1), as well as biologically interpretable trans-eQTL examples (e.g., REST and STING1), all fine-mapped at single variant resolution. We perform differential gene expression analysis to elucidate 198 genes with increased expression in severe COVID-19 cases and enriched for innate immune-related functions. Finally, we evaluate the limited but non-zero effect of COVID-19 phenotype on eQTL discovery, and highlight the presence of COVID-19 severity-interaction eQTLs (ieQTLs; e.g., CLEC4C and MYBL2). Our study provides a comprehensive catalog of whole blood regulatory variants in Japanese, as well as a reference for transcriptional landscapes in response to COVID-19 infection. Genetic mechanisms influencing COVID-19 susceptibility are not well understood. Here, the authors analyzed whole blood RNA-seq data of 465 Japanese individuals with COVID-19, highlighting thousands of fine-mapped variants affecting expression and splicing of genes, as well as the presence of COVID-19 severity-interaction eQTLs.
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Anan K, Oshima Y, Ogura T, Tanabe Y, Higashi A, Iwashita Y, Fujita K, Yoshida T, Ando K, Okamori S, Okada Y. Author's reply. Respir Investig 2022; 60:863-864. [PMID: 35999141 DOI: 10.1016/j.resinv.2022.07.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2022] [Accepted: 07/17/2022] [Indexed: 11/26/2022]
Affiliation(s)
- Keisuke Anan
- Division of Respiratory Medicine, Saiseikai Kumamoto Hospital, Kumamoto, Japan.
| | | | - Takayuki Ogura
- Department of Emergency Medicine and Critical Care Medicine, Tochigi Prefectural Emergency and Critical Care Centre, Imperial Foundation Saiseikai Utsunomiya Hospital, Tochigi, Japan
| | - Yuko Tanabe
- Department of Medical Oncology, Toranomon Hospital, Tokyo, Japan
| | - Akiko Higashi
- Department of Emergency and Critical Care Medicine, Chiba University Graduate School of Medicine, Chiba, Japan
| | - Yoshiaki Iwashita
- Department of Emergency and Critical Care Medicine, Shimane University, Shimane, Japan
| | - Kensuke Fujita
- Department of Emergency Medicine and Critical Care Medicine, Tochigi Prefectural Emergency and Critical Care Centre, Imperial Foundation Saiseikai Utsunomiya Hospital, Tochigi, Japan
| | - Takuo Yoshida
- Intensive Care Unit, Department of Anesthesiology, Jikei University School of Medicine, Tokyo, Japan
| | - Koichi Ando
- Division of Allergology and Respiratory Medicine, Department of Medicine, Showa University School of Medicine, Tokyo, Japan
| | - Satoshi Okamori
- Division of Pulmonary Medicine, Department of Medicine, Keio University School of Medicine, Tokyo, Japan
| | - Yohei Okada
- Department of Primary Care and Emergency Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan; Preventive Services, School of Public Health in the Graduate School of Medicine, Kyoto University, Kyoto, Japan
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22
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Ogura T, Hirata A, Kagtagiri T, Takakura Y, Kameda H. AB0381 ULTRASONOGRAPHY TO PREDICT FLARE AFTER DISCONTINUATION OF BIOLOGICS IN PATIENTS WITH RHEUMATOID ARTHRITIS IN REMISSION. Ann Rheum Dis 2022. [DOI: 10.1136/annrheumdis-2022-eular.5399] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BackgroundUltrasonography (US) has been suggested to be useful in predicting flare in patients with rheumatoid arthritis (RA) after discontinuation of biological disease-modifying antirheumatic drugs (bDMARDs).ObjectivesThis study aimed to investigate whether US can predict flare after discontinuation of bDMARDs in RA patients who have achieved stringent remission criteria.MethodsWe prospectively enrolled RA patients who maintained a simplified disease activity index ≤ 3.3 and discontinued bDMARDs and measured clinical assessment and US every 2-3 months for 2 years. The US examination was performed on 40 joints using the semi-quantitative method of 0-3 on the Grey-scale (GS) and Power Doppler (PD), and the total values for each patient were used as the GS score and PD score. Joints graded as GS score ≥ 2 or PD score ≥ 1 were counted as US arthritis. In addition, tendons at 36 sites were counted with or without tendinitis/tenosynovitis to obtain a tendon score.ResultsThirty-six patients were enrolled and two patients who dropped out early without flare were excluded from the comparative analyses. At baseline, the median GS score was 7, PD score was 0, US arthritis was 0, and tendon score was 0. The total PD score was 0 in 26 patients (72%) and it was 1 in 5 patients (14%). There were no significant differences in US findings between the relapse group (20 patients) and the non-relapse group (14 patients). Positive and negative predictive value for PD-positive findings (total PD score ≥1) were 60% and 42%, and for total PD score ≥2 were 60% and 41%, respectively.ConclusionThe PD score in the US findings at the time of bDMARDs discontinuation was not predictive for future disease flare.Disclosure of InterestsTakehisa Ogura Speakers bureau: AbbVie G.K, Ayako Hirata: None declared, Takaharu Kagtagiri: None declared, Yuto Takakura: None declared, Hideto Kameda Speakers bureau: AbbVie G.K., Asahi Kasei Pharma, Astellas Pharma Inc., Bristol-Myers Squibb, Chugai Pharmaceutical Co. Ltd., Eisai Co. Ltd., Eli Lilly Japan K.K., Gilead Sciences, Janssen Pharmaceutical K.K., Mitsubishi Tanabe Pharma, Novartis Pharma K.K., and Sanofi Pharma, Grant/research support from: AbbVie G.K., Asahi Kasei Pharma, Astellas Pharma Inc., Chugai Pharmaceutical Co. Ltd., Eisai Co. Ltd., Mitsubishi Tanabe Pharma, Novartis Pharma K.K., and Sanofi Pharma
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Kiyozumi T, Saitoh D, Ogura T, Morino K, Takeda T, Narumi A, Hashimoto I, Sasaki J, Sakurai H. Impact of COVID-19 pandemic on the care of severe burns in Japan: Repeated survey of specialized burn care facilities. Burns 2022; 49:934-940. [PMID: 35787968 PMCID: PMC9225939 DOI: 10.1016/j.burns.2022.06.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Revised: 06/09/2022] [Accepted: 06/20/2022] [Indexed: 11/28/2022]
Abstract
Background The spread of coronavirus disease 2019 (COVID-19), which began in 2020, has had a major impact on healthcare systems. The spread of COVID-19 has been reported to have affected the readiness to treat patients with burns worldwide. However, the existing reports have evaluated burn care status within a limited time period during the pandemic, and no report clarifies the change in the impact of infection status on burn care from the beginning of the pandemic to the present. Methods Japanese Society for Burn Injuries–accredited burn care facilities were surveyed using questionnaires on April 9–23, 2020; June 23–July 6, 2020; July 9–21, 2021; and January 21–31, 2022. Differences between groups were evaluated using Friedman’s test or Bonferroni’s multiple comparison test, as appropriate. Results From the 103 facilities included in the study, we received 85, 55, 56, and 58 responses in the first, second, third, and fourth surveys, respectively. We could continuously observe 34 facilities. The rate of acceptance of patients with severe burns improved significantly over time (P < 0.05). However, in the second and third surveys, there was an increase in the number of respondents who did not accept patients with burns irrespective of COVID-19 status. Conclusions The number of facilities treating patients with burns who have COVID-19 is increasing; however, COVID-19 care may negatively impact routine burn care. It is necessary to continuously examine medical resource allocation through methods such as information sharing by academic societies.
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Affiliation(s)
- Tetsuro Kiyozumi
- Department of Defense Medicine, National Defense Medical College, 3-2 Namiki, Tokorozawa City, Saitama Prefecture, Japan.
| | - Daizoh Saitoh
- Division of Traumatology, Research Institute, Department of Traumatology and Critical Care, Hospital, National Defense Medical College, 3-2 Namiki, Tokorozawa, Saitama, Japan
| | - Takayuki Ogura
- Tochigi Prefectural Emergency and Critical Care Center, Imperial Gift Foundation SAISEIKAI, Utsunomiya Hospital, Takebayashi-Machi 911-1, Utsumomiya, Tochigi, Japan
| | - Kazuma Morino
- Yamagata Prefectural Central Hospital, Aoyagi, Yamagata city, Yamagata prefecture 990-2292, Japan
| | - Taichi Takeda
- Koga-Bando Clinical Education and Training Center, University of Tsukuba Hospital, 1-1-1 Tennodai, Tsukuba, Ibaraki, Japan
| | - Atsushi Narumi
- Youmeikai Obase Hospital, Aratsu 1589, Miyako-Gun, Fukuoka Prefecture, Japan
| | - Ichiro Hashimoto
- Tokushima University Graduate School of Medicine, Department of Plastic and Reconstructive Surgery, 18-15 3Chome Kuramoto-cho, Tokushima, Japan
| | - Junichi Sasaki
- Department of Emergency & Critical Care Medicine, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, Japan
| | - Hiroyuki Sakurai
- Department of Plastic and Reconstructive Surgery, Tokyo Women's Medical University, 8-1 Kawada-cho, Shinjuku-ku, Tokyo, Japan
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24
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Umemura T, Hatano T, Ogura T, Miyata T, Agawa Y, Nakajima H, Tomoyose R, Sakamoto H, Tsujimoto Y, Nakazawa Y, Wakabayashi T, Hashimoto T, Fujiki R, Shiraishi W, Nagata I. ADC Level is Related to DWI Reversal in Patients Undergoing Mechanical Thrombectomy: A Retrospective Cohort Study. AJNR Am J Neuroradiol 2022; 43:893-898. [PMID: 35550283 DOI: 10.3174/ajnr.a7510] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2021] [Accepted: 03/17/2022] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE In patients with ischemic stroke, DWI lesions can occasionally be reversed by reperfusion therapy. This study aimed to ascertain the relationship between ADC levels and DWI reversal in patients with acute ischemic stroke who underwent recanalization treatment. MATERIALS AND METHODS We conducted a retrospective cohort study in patients with acute ischemic stroke who underwent endovascular mechanical thrombectomy with successful recanalization between April 2017 and March 2021. DWI reversal was assessed through follow-up MR imaging approximately 24 hours after treatment. RESULTS In total, 118 patients were included. DWI reversal was confirmed in 42 patients. The ADC level in patients with reversal was significantly higher than that in patients without reversal. Eighty-three percent of patients with DWI reversal areas had mean ADC levels of ≥520 × 10-6 mm2/s, and 71% of patients without DWI reversal areas had mean ADC levels of <520 × 10-6 mm2/s. The mean ADC threshold was 520 × 10-6 mm2/s with a sensitivity and specificity of 71% and 83%, respectively. In multivariate analysis, the mean ADC level (OR, 1.023; 95% CI, 1.013-1.033; P < .0001) was independently associated with DWI reversal. Patients with DWI reversal areas had earlier neurologic improvement (NIHSS at 7 days) than patients without reversal areas (P < .0001). CONCLUSIONS In acute ischemic stroke, the ADC value is independently associated with DWI reversal. Lesions with a mean ADC of ≥520 × 10-6 mm2/s are salvageable by mechanical thrombectomy, and DWI reversal areas regain neurologic function. The ADC value is easily assessed and is a useful tool to predict viable lesions.
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Affiliation(s)
- T Umemura
- From the Department of Neurosurgery (T.U., T.H., T.O., T.M., Y.A., N.H., R.T., H.S., Y.T., Y.N., T.W., I.N.), Stroke Center, Kokura Memorial Hospital, Kitakyushu City, Japan
| | - T Hatano
- From the Department of Neurosurgery (T.U., T.H., T.O., T.M., Y.A., N.H., R.T., H.S., Y.T., Y.N., T.W., I.N.), Stroke Center, Kokura Memorial Hospital, Kitakyushu City, Japan
| | - T Ogura
- From the Department of Neurosurgery (T.U., T.H., T.O., T.M., Y.A., N.H., R.T., H.S., Y.T., Y.N., T.W., I.N.), Stroke Center, Kokura Memorial Hospital, Kitakyushu City, Japan
| | - T Miyata
- From the Department of Neurosurgery (T.U., T.H., T.O., T.M., Y.A., N.H., R.T., H.S., Y.T., Y.N., T.W., I.N.), Stroke Center, Kokura Memorial Hospital, Kitakyushu City, Japan
| | - Y Agawa
- From the Department of Neurosurgery (T.U., T.H., T.O., T.M., Y.A., N.H., R.T., H.S., Y.T., Y.N., T.W., I.N.), Stroke Center, Kokura Memorial Hospital, Kitakyushu City, Japan
| | - H Nakajima
- From the Department of Neurosurgery (T.U., T.H., T.O., T.M., Y.A., N.H., R.T., H.S., Y.T., Y.N., T.W., I.N.), Stroke Center, Kokura Memorial Hospital, Kitakyushu City, Japan
| | - R Tomoyose
- From the Department of Neurosurgery (T.U., T.H., T.O., T.M., Y.A., N.H., R.T., H.S., Y.T., Y.N., T.W., I.N.), Stroke Center, Kokura Memorial Hospital, Kitakyushu City, Japan
| | - H Sakamoto
- From the Department of Neurosurgery (T.U., T.H., T.O., T.M., Y.A., N.H., R.T., H.S., Y.T., Y.N., T.W., I.N.), Stroke Center, Kokura Memorial Hospital, Kitakyushu City, Japan
| | - Y Tsujimoto
- From the Department of Neurosurgery (T.U., T.H., T.O., T.M., Y.A., N.H., R.T., H.S., Y.T., Y.N., T.W., I.N.), Stroke Center, Kokura Memorial Hospital, Kitakyushu City, Japan
| | - Y Nakazawa
- From the Department of Neurosurgery (T.U., T.H., T.O., T.M., Y.A., N.H., R.T., H.S., Y.T., Y.N., T.W., I.N.), Stroke Center, Kokura Memorial Hospital, Kitakyushu City, Japan
| | - T Wakabayashi
- From the Department of Neurosurgery (T.U., T.H., T.O., T.M., Y.A., N.H., R.T., H.S., Y.T., Y.N., T.W., I.N.), Stroke Center, Kokura Memorial Hospital, Kitakyushu City, Japan
| | - T Hashimoto
- Department of Neurology (T.H., R.F., W.B.), Stroke Center, Kokura Memorial Hospital, Kitakyushu City, Japan
| | - R Fujiki
- Department of Neurology (T.H., R.F., W.B.), Stroke Center, Kokura Memorial Hospital, Kitakyushu City, Japan
| | - W Shiraishi
- Department of Neurology (T.H., R.F., W.B.), Stroke Center, Kokura Memorial Hospital, Kitakyushu City, Japan
| | - I Nagata
- From the Department of Neurosurgery (T.U., T.H., T.O., T.M., Y.A., N.H., R.T., H.S., Y.T., Y.N., T.W., I.N.), Stroke Center, Kokura Memorial Hospital, Kitakyushu City, Japan
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25
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Inoue A, Hifumi T, Sakamoto T, Okamoto H, Kunikata J, Yokoi H, Sawano H, Egawa Y, Kato S, Sugiyama K, Bunya N, Kasai T, Ijuin S, Nakayama S, Kanda J, Kanou S, Takiguchi T, Yokobori S, Takada H, Inoue K, Takeuchi I, Honzawa H, Kobayashi M, Hamagami T, Takayama W, Otomo Y, Maekawa K, Shimizu T, Nara S, Nasu M, Takahashi K, Hagiwara Y, Kushimoto S, Fukuda R, Ogura T, Shiraishi SI, Zushi R, Otani N, Kikuchi M, Watanabe K, Nakagami T, Shoko T, Kitamura N, Otani T, Matsuoka Y, Aoki M, Sakuraya M, Arimoto H, Homma K, Naito H, Nakao S, Okazaki T, Tahara Y, Kuroda Y. Extracorporeal cardiopulmonary resuscitation in adult patients with out-of-hospital cardiac arrest: a retrospective large cohort multicenter study in Japan. Crit Care 2022; 26:129. [PMID: 35534870 DOI: 10.1186/s13054-022-03998-y] [Citation(s) in RCA: 50] [Impact Index Per Article: 25.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Accepted: 04/24/2022] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND The prevalence of extracorporeal cardiopulmonary resuscitation (ECPR) in patients with out-of-hospital cardiac arrest (OHCA) has been increasing rapidly worldwide. However, guidelines or clinical studies do not provide sufficient data on ECPR practice. The aim of this study was to provide real-world data on ECPR for patients with OHCA, including details of complications. METHODS We did a retrospective database analysis of observational multicenter cohort study in Japan. Adult patients with OHCA of presumed cardiac etiology who received ECPR between 2013 and 2018 were included. The primary outcome was favorable neurological outcome at hospital discharge, defined as a cerebral performance category of 1 or 2. RESULTS A total of 1644 patients with OHCA were included in this study. The patient age was 18-93 years (median: 60 years). Shockable rhythm in the initial cardiac rhythm at the scene was 69.4%. The median estimated low flow time was 55 min (interquartile range: 45-66 min). Favorable neurological outcome at hospital discharge was observed in 14.1% of patients, and the rate of survival to hospital discharge was 27.2%. The proportions of favorable neurological outcome at hospital discharge in terms of shockable rhythm, pulseless electrical activity, and asystole were 16.7%, 9.2%, and 3.9%, respectively. Complications were observed during ECPR in 32.7% of patients, and the most common complication was bleeding, with the rates of cannulation site bleeding and other types of hemorrhage at 16.4% and 8.5%, respectively. CONCLUSIONS In this large cohort, data on the ECPR of 1644 patients with OHCA show that the proportion of favorable neurological outcomes at hospital discharge was 14.1%, survival rate at hospital discharge was 27.2%, and complications were observed during ECPR in 32.7%.
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Affiliation(s)
- Akihiko Inoue
- Department of Emergency and Critical Care Medicine, Hyogo Emergency Medical Center, Kobe, Japan
| | - Toru Hifumi
- Department of Emergency and Critical Care Medicine, St. Luke's International Hospital, 9-1 Akashi-cho, Chuo-ku, Tokyo, 104-8560, Japan.
| | - Tetsuya Sakamoto
- Department of Emergency Medicine, Teikyo University School of Medicine, Tokyo, Japan
| | - Hiroshi Okamoto
- Department of Critical Care Medicine, St. Luke's International Hospital, Tokyo, Japan
| | - Jun Kunikata
- Clinical Research Support Center, Kagawa University Hospital, Kagawa, Japan
| | - Hideto Yokoi
- Clinical Research Support Center, Kagawa University Hospital, Kagawa, Japan
| | - Hirotaka Sawano
- Senri Critical Care Medical Center, Osaka Saiseikai Senri Hospital, Suita, Japan
| | - Yuko Egawa
- Advanced Emergency and Critical Care Center, Saitama Red Cross Hospital, Saitama, Japan
| | - Shunichi Kato
- Advanced Emergency and Critical Care Center, Saitama Red Cross Hospital, Saitama, Japan
| | - Kazuhiro Sugiyama
- Tertiary Emergency Medical Center, Tokyo Metropolitan Bokutoh Hospital, Tokyo, Japan
| | - Naofumi Bunya
- Department of Emergency Medicine, Sapporo Medical University, Hokkaido, Japan
| | - Takehiko Kasai
- Department of Emergency Medicine, Sapporo Medical University, Hokkaido, Japan
| | - Shinichi Ijuin
- Department of Emergency and Critical Care Medicine, Hyogo Emergency Medical Center, Kobe, Japan
| | - Shinichi Nakayama
- Department of Emergency and Critical Care Medicine, Hyogo Emergency Medical Center, Kobe, Japan
| | - Jun Kanda
- Department of Emergency Medicine, Teikyo University School of Medicine, Tokyo, Japan
| | - Seiya Kanou
- Department of Emergency Medicine, Teikyo University School of Medicine, Tokyo, Japan
| | - Toru Takiguchi
- Department of Emergency and Critical Care Medicine, Nippon Medical School, Tokyo, Japan
| | - Shoji Yokobori
- Department of Emergency and Critical Care Medicine, Nippon Medical School, Tokyo, Japan
| | - Hiroaki Takada
- Department of Critical Care Medicine and Trauma, National Hospital Organization Disaster Medical Center, Tokyo, Japan
| | - Kazushige Inoue
- Department of Critical Care Medicine and Trauma, National Hospital Organization Disaster Medical Center, Tokyo, Japan
| | - Ichiro Takeuchi
- Advanced Critical Care and Emergency Center, Yokohama City University Medical Center, Yokohama, Japan
| | - Hiroshi Honzawa
- Advanced Critical Care and Emergency Center, Yokohama City University Medical Center, Yokohama, Japan
| | - Makoto Kobayashi
- Tajima Emergency and Critical Care Medical Center, Toyooka Public Hospital, Hyogo, Japan
| | - Tomohiro Hamagami
- Tajima Emergency and Critical Care Medical Center, Toyooka Public Hospital, Hyogo, Japan
| | - Wataru Takayama
- Trauma and Acute Critical Care Center, Tokyo Medical and Dental University Hospital of Medicine, Tokyo, Japan
| | - Yasuhiro Otomo
- Trauma and Acute Critical Care Center, Tokyo Medical and Dental University Hospital of Medicine, Tokyo, Japan
| | - Kunihiko Maekawa
- Department of Emergency Medicine, Hokkaido University Hospital, Sapporo, Japan
| | - Takafumi Shimizu
- Emergency and Critical Care Medical Center, Teine Keijinkai Hospital, Sapporo, Japan
| | - Satoshi Nara
- Emergency and Critical Care Medical Center, Teine Keijinkai Hospital, Sapporo, Japan
| | - Michitaka Nasu
- Department of Emergency and Critical Care Medicine, Urasoe General Hospital, Okinawa, Japan
| | - Kuniko Takahashi
- Department of Emergency and Critical Care Medicine, Urasoe General Hospital, Okinawa, Japan
| | - Yoshihiro Hagiwara
- Department of Emergency Medicine and Critical Care Medicine Tochigi Prefectural Emergency and Critical Care Center, Imperial Gift Foundation Saiseikai, Utsunomiya Hospital, Tochigi, Japan
| | - Shigeki Kushimoto
- Division of Emergency and Critical Care Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Reo Fukuda
- Department of Emergency and Critical Care Medicine, Nippon Medical School Tama Nagayama Hospital, Tokyo, Japan
| | - Takayuki Ogura
- Department of Emergency Medicine and Critical Care Medicine Tochigi Prefectural Emergency and Critical Care Center, Imperial Gift Foundation Saiseikai, Utsunomiya Hospital, Tochigi, Japan.,Department of Emergency Medicine and Critical Care Medicine, Advanced Medical Emergency Department and Critical Care Center, Japan Red Cross Maebashi Hospital, Maebashi, Japan
| | - Shin-Ichiro Shiraishi
- Department of Emergency and Critical Care Medicine, Aizu Central Hospital, Fukushima, Japan
| | - Ryosuke Zushi
- Emergency Medicine, Osaka Mishima Emergency Critical Care Center, Takatsuki, Japan
| | - Norio Otani
- Department of Emergency and Critical Care Medicine, St. Luke's International Hospital, 9-1 Akashi-cho, Chuo-ku, Tokyo, 104-8560, Japan
| | - Migaku Kikuchi
- Emergency and Critical Care Center, Dokkyo Medical University, Tochigi, Japan
| | | | - Takuo Nakagami
- Department of Cardiovascular Medicine, Omihachiman Community Medical Center, Shiga, Japan
| | - Tomohisa Shoko
- Department of Emergency and Critical Care Medicine, Tokyo Women's Medical University Medical Center East, Tokyo, Japan
| | - Nobuya Kitamura
- Department of Emergency and Critical Care Medicine, Kimitsu Chuo Hospital, Chiba, Japan
| | - Takayuki Otani
- Department of Emergency Medicine, Hiroshima City Hiroshima Citizens Hospital, Hiroshima, Japan
| | - Yoshinori Matsuoka
- Department of Emergency Medicine, Kobe City Medical Center General Hospital, Kobe, Japan
| | - Makoto Aoki
- Department of Emergency Medicine, Gunma University Graduate School of Medicine, Maebashi, Japan
| | - Masaaki Sakuraya
- Department of Emergency and Intensive Care Medicine, JA Hiroshima General Hospital, Hiroshima, Japan
| | - Hideki Arimoto
- Emergency and Critical Care Medical Center, Osaka City General Hospital, Osaka, Japan
| | - Koichiro Homma
- Department of Emergency and Critical Care Medicine, Keio University School of Medicine, Tokyo, Japan
| | - Hiromichi Naito
- Advanced Emergency and Critical Care Medical Center, Okayama University Hospital, Okayama, Japan
| | - Shunichiro Nakao
- Department of Traumatology and Acute Critical Medicine, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Tomoya Okazaki
- Department of Emergency, Disaster and Critical Care Medicine, Kagawa University Hospital, Kagawa, Japan
| | - Yoshio Tahara
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Japan
| | - Yasuhiro Kuroda
- Department of Emergency, Disaster and Critical Care Medicine, Kagawa University Hospital, Kagawa, Japan
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26
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Yamamoto R, Kaito D, Homma K, Endo A, Tagami T, Suzuki M, Umetani N, Yagi M, Nashiki E, Suhara T, Nagata H, Kabata H, Fukunaga K, Yamakawa K, Hayakawa M, Ogura T, Hirayama A, Yasunaga H, Sasaki J. Early intubation and decreased in-hospital mortality in patients with coronavirus disease 2019. Crit Care 2022; 26:124. [PMID: 35524282 PMCID: PMC9073819 DOI: 10.1186/s13054-022-03995-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Accepted: 04/27/2022] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Some academic organizations recommended that physicians intubate patients with COVID-19 with a relatively lower threshold of oxygen usage particularly in the early phase of pandemic. We aimed to elucidate whether early intubation is associated with decreased in-hospital mortality among patients with novel coronavirus disease 2019 (COVID-19) who required intubation. METHODS A multicenter, retrospective, observational study was conducted at 66 hospitals in Japan where patients with moderate-to-severe COVID-19 were treated between January and September 2020. Patients who were diagnosed as COVID-19 with a positive reverse-transcription polymerase chain reaction test and intubated during admission were included. Early intubation was defined as intubation conducted in the setting of ≤ 6 L/min of oxygen usage. In-hospital mortality was compared between patients with early and non-early intubation. Inverse probability weighting analyses with propensity scores were performed to adjust patient demographics, comorbidities, hemodynamic status on admission and time at intubation, medications before intubation, severity of COVID-19, and institution characteristics. Subgroup analyses were conducted on the basis of age, severity of hypoxemia at intubation, and days from admission to intubation. RESULTS Among 412 patients eligible for the study, 110 underwent early intubation. In-hospital mortality was lower in patients with early intubation than those with non-early intubation (18 [16.4%] vs. 88 [29.1%]; odds ratio, 0.48 [95% confidence interval 0.27-0.84]; p = 0.009, and adjusted odds ratio, 0.28 [95% confidence interval 0.19-0.42]; p < 0.001). The beneficial effects of early intubation were observed regardless of age and severity of hypoxemia at time of intubation; however, early intubation was associated with lower in-hospital mortality only among patients who were intubated later than 2 days after admission. CONCLUSIONS Early intubation in the setting of ≤ 6 L/min of oxygen usage was associated with decreased in-hospital mortality among patients with COVID-19 who required intubation. Trial Registration None.
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Affiliation(s)
- Ryo Yamamoto
- Department of Emergency and Critical Care Medicine, Keio University School of Medicine, 35 Shinanomachi, Shinjuku, Tokyo, 160-8582, Japan.
| | - Daiki Kaito
- Department of Emergency and Critical Care Medicine, Keio University School of Medicine, 35 Shinanomachi, Shinjuku, Tokyo, 160-8582, Japan
| | - Koichiro Homma
- Department of Emergency and Critical Care Medicine, Nippon Medical School Musashikosugi Hospital, Kawasaki, Kanagawa, Japan
| | - Akira Endo
- Trauma and Acute Critical Care Center, Tokyo Medical and Dental University Hospital, Tokyo, Japan
| | - Takashi Tagami
- Department of Emergency and Critical Care Medicine, Nippon Medical School Musashikosugi Hospital, Kawasaki, Kanagawa, Japan.,Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, Tokyo, Japan
| | - Morio Suzuki
- Department of Emergency and Critical Care Medicine, Kawakita General Hospital, Tokyo, Japan
| | - Naoyuki Umetani
- Department of Emergency and Critical Care Medicine, Kawakita General Hospital, Tokyo, Japan
| | - Masayuki Yagi
- Emergency Medicine and Acute Care Surgery, Matsudo City General Hospital, Chiba, Japan
| | - Eisaku Nashiki
- Department of Emergency and Critical Care Medicine, Yokohama City Minato Red Cross Hospital, Yokohama, Kanagawa, Japan
| | - Tomohiro Suhara
- Department of Anesthesiology, Keio University School of Medicine, Tokyo, Japan
| | - Hiromasa Nagata
- Department of Anesthesiology, Keio University School of Medicine, Tokyo, Japan
| | - Hiroki Kabata
- Division of Pulmonary Medicine, Department of Medicine, Keio University School of Medicine, Tokyo, Japan
| | - Koichi Fukunaga
- Division of Pulmonary Medicine, Department of Medicine, Keio University School of Medicine, Tokyo, Japan
| | - Kazuma Yamakawa
- Department of Emergency Medicine, Osaka Medical and Pharmaceutical University, Osaka, Japan
| | - Mineji Hayakawa
- Department of Emergency Medicine, Hokkaido University Hospital, Sapporo, Hokkaido, Japan
| | - Takayuki Ogura
- Department of Emergency Medicine and Critical Care Medicine, Tochigi Prefectural Emergency and Critical Care Centre, Imperial Foundation Saiseikai Utsunomiya Hospital, Tochigi, Japan
| | - Atsushi Hirayama
- Public Health, Department of Social Medicine, Graduate School of Medicine, Osaka University, Osaka, Japan
| | - Hideo Yasunaga
- Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, Tokyo, Japan
| | - Junichi Sasaki
- Department of Emergency and Critical Care Medicine, Keio University School of Medicine, 35 Shinanomachi, Shinjuku, Tokyo, 160-8582, Japan
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27
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Liu K, Shibata J, Fukuchi K, Takahashi K, Sonoo T, Ogura T, Goto T. Optimal timing of introducing mobilization therapy for ICU patients with sepsis. J Intensive Care 2022; 10:22. [PMID: 35468868 PMCID: PMC9036689 DOI: 10.1186/s40560-022-00613-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Accepted: 04/11/2022] [Indexed: 12/14/2022] Open
Abstract
Background For patients admitted to the intensive care unit (ICU) with sepsis, mobilization therapy during ICU stay can improve their outcomes during and after the ICU stay. However, little is known about the optimal timing of introducing mobilization therapy. Methods This is a retrospective cohort study using data from a tertiary medical center in Japan during 2013–2017. We included patients aged ≥ 18 years who were admitted to the ICU with sepsis based on the Sepsis-3 criteria. We defined early mobilization (EM) as the rehabilitation at the level of sitting on the edge of the bed or more within the first 3 days of the patients’ ICU stay. Patients were divided into the EM and non-EM groups. The primary outcomes were in-hospital mortality and ambulatory dependence at hospital discharge. We estimated the effects of EM by stabilized inverse probability weighting (sIPW). We then tested alternative definitions of EM by changing the cutoff in days to mobilization by 1-day increments from 2 to 7 days to investigate the optimal timing of mobilization. Results Our study sample consisted of a total of 296 septic patients, including 96 patients in the EM group and 200 patients in the non-EM group. In the sIPW model, the adjusted OR for in-hospital mortality in the EM group compared to the non-EM group was 0.22 [95% CI 0.06–0.88], and the adjusted OR for ambulatory dependence at the hospital discharge was 0.24 [95% CI 0.09–0.61]. When alternative definitions of EM were tested, patients who achieved mobilization within the first 2–4 days of their ICU stays had better outcomes. Conclusions Achieving mobilization within the first 3 days of ICU stay was significantly associated with better outcomes. Patients with sepsis might benefit most from achieving mobilization within 2–4 days. Further studies are warranted to validate the findings. Supplementary Information The online version contains supplementary material available at 10.1186/s40560-022-00613-8.
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Hifumi T, Inoue A, Otani T, Otani N, Kushimoto S, Sakamoto T, Kuroda Y, Takiguchi T, Watanabe K, Ogura T, Okazaki T, Ijuin S, Zushi R, Arimoto H, Takada H, Shiraishi SI, Egawa Y, Kanda J, Nasu M, Kobayashi M, Sakuraya M, Naito H, Nakao S, Takeuchi I, Bunya N, Shimizu T, Sawano H, Takayama W, Shoko T, Aoki M, Matsuoka Y, Homma K, Maekawa K, Tahara Y, Fukuda R, Kikuchi M, Nakagami T, Hagiwara Y, Kitamura N, Sugiyama K. Details of Targeted Temperature Management Methods for Patients Who Had Out-of-Hospital Cardiac Arrest Receiving Extracorporeal Cardiopulmonary Resuscitation: A Questionnaire Survey. Ther Hypothermia Temp Manag 2022; 12:215-222. [DOI: 10.1089/ther.2022.0004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Toru Hifumi
- Department of Emergency and Critical Care Medicine, St. Luke's International Hospital, Tokyo, Japan
| | - Akihiko Inoue
- Department of Emergency and Critical Care Medicine, Hyogo Emergency Medical Center, Kobe, Japan
| | - Takayuki Otani
- Department of Emergency Medicine, Hiroshima City Hiroshima Citizens Hospital, Hiroshima, Japan
| | - Norio Otani
- Department of Emergency and Critical Care Medicine, St. Luke's International Hospital, Tokyo, Japan
| | - Shigeki Kushimoto
- Division of Emergency and Critical Care Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Tetsuya Sakamoto
- Trauma and Resuscitation Center, Teikyo University Hospital, Tokyo, Japan
| | - Yasuhiro Kuroda
- Department of Emergency, Disaster and Critical Care Medicine, Kagawa University Hospital, Kagawa, Japan
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Liu K, Kotani T, Nakamura K, Chihiro T, Morita Y, Ishii K, Fujizuka K, Yasumura D, Taniguchi D, Hamagami T, Shimojo N, Nitta M, Hongo T, Akieda K, Atsuo M, Kaneko T, Sakuda Y, Andoh K, Nagatomi A, Tanaka Y, Irie Y, Kamijo H, Hanazawa M, Kasugai D, Ayaka M, Oike K, Lefor AK, Takahashi K, Katsukawa H, Ogura T. Effects of evidence-based ICU care on long-term outcomes of patients with sepsis or septic shock (ILOSS): protocol for a multicentre prospective observational cohort study in Japan. BMJ Open 2022; 12:e054478. [PMID: 35351710 PMCID: PMC8961143 DOI: 10.1136/bmjopen-2021-054478] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
INTRODUCTION Sepsis is not only the leading cause of death in the intensive care unit (ICU) but also a major risk factor for physical and cognitive impairment and mental disorders, known as postintensive care syndrome (PICS), reduced health-related quality of life (HRQoL) and even mental health disorders in patient families (PICS-family; PICS-F). The ABCDEF bundle is strongly recommended to overcome them, while the association between implementing the bundle and the long-term outcomes is also unknown. METHODS AND ANALYSIS This is a multicentre prospective observational study at 26 ICUs. All consecutive patients between 1 November 2020 and 30 April 2022, who are 18 years old or older and expected to stay in an ICU for more than 48 hours due to sepsis or septic shock, are enrolled. Follow-up to evaluate survival and PICS/ PICS-F will be performed at 3, 6 and 12 months and additionally every 6 months up to 5 years after hospital discharge. Primary outcomes include survival at 12 months, which is the primary outcome, and the incidence of PICS defined as the presence of any physical impairment, cognitive impairment or mental disorders. PICS assessment scores, HRQoL and employment status are evaluated. The association between the implementation rate for the ABCDEF bundle and for each of the individual elements and long-term outcomes will be evaluated. The PICS-F, defined as the presence of mental disorders, and HRQoL of the family is also assessed. Additional analyses with data up to 5 years follow-up are planned. ETHICS AND DISSEMINATION This study received ethics approvals from Saiseikai Utsunomiya Hospital (2020-42) and all other participating institutions and was registered in the University Hospital Medical Information Network Clinical Trials Registry. Informed consent will be obtained from all patients. The findings will be published in peer-reviewed journals and presented at scientific conferences. TRIAL REGISTRATION NUMBER UMIN000041433.
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Affiliation(s)
- Keibun Liu
- Critical Care Research Group, The Prince Charles Hospital, Brisbane, Queensland, Australia
| | - Toru Kotani
- Department of Intensive Care Medicine, Showa University School of Medicine, Tokyo, Japan
| | - Kensuke Nakamura
- Department of Emergency and Critical Care Medicine, Hitachi General Hospital, Hitachi, Ibaraki, Japan
| | - Takai Chihiro
- Department of Emergency Medicine and Critical Care Medicine, Tochigi prefectural emergency and critical care center, Saiseikai Utsunomiya Hospital, Utsunomiya, Tochigi, Japan
| | - Yasunari Morita
- Department of Emergency and Intensive Care Medicine, National Hospital Organization Nagoya Medical Center, Nagoya, Japan
| | - Kenzo Ishii
- Department of Anesthesiology, Intensive Care Unit, Fukuyama City Hospital, Fukuyama, Hiroshima, Japan
| | - Kenji Fujizuka
- Advanced Medical Emergency Department and Critical Care Center, Japan Red Cross Maebashi Hospital, Maebashi, Maebashi, Japan
| | - Daisetsu Yasumura
- Department of Rehabilitation, Naha City Hospital, Naha, Okinawa, Japan
| | - Daisuke Taniguchi
- Tajima Emergency & Critical Care Medical Center, Toyooka Public Hospital, Toyooka, Japan
| | - Tomohiro Hamagami
- Tajima Emergency & Critical Care Medical Center, Toyooka Public Hospital, Toyooka, Japan
| | - Nobutake Shimojo
- Emergency and Critical Care Medicine, University of Tsukuba Faculty of Medicine, Tsukuba, Ibaraki, Japan
| | - Masakazu Nitta
- Department of Intensive Care Unit, Niigata University Medical and Dental Hospital, Niigata, Niigata, Japan
| | - Takashi Hongo
- Emergency Department, Okayama Saiseikai General Hospital, Okayama, Japan
| | - Kazuki Akieda
- Department of Emergency Medicine, SUBARU Health Insurance Society Ota Memorial Hospital, Ota, Japan
| | - Maeda Atsuo
- Department of Emergency and Disaster Medicine, Showa University Fujigaoka Hospital, Yokohama, Kanagawa, Japan
| | - Tadashi Kaneko
- Emergency and Critical Care Center, Mie University Hospital, Tsu, Mie, Japan
| | - Yutaka Sakuda
- Department of Intensive Care Medicine, Okinawa Kyodo Hospital, Naha, Okinawa, Japan
| | - Kohkichi Andoh
- Division of Anesthesiology, Sendai City Hospital, Sendai, Miyagi, Japan
| | - Akiyoshi Nagatomi
- Department of Emergency medicine and Critical Care, St. Marianna University School of Medicine, Yokohama-City Seibu Hospital, Yokohama, Japan
| | - Yukiko Tanaka
- Department of emergency, Tsukuba Medical Center Hospital, Tsukuba, Ibaraki, Japan
| | - Yuhei Irie
- Department of Emergency and Critical care medicine, Fukuoka University Hospital, Fukuoka, Japan
| | - Hiroshi Kamijo
- Intensive Care Unit, Shinshu University Hospital, Matsumoto, Nagano, Japan
| | - Manabu Hanazawa
- Department of Rehabilitation, Japan Red Cross Narita Hospital, Narita, Japan
| | - Daisuke Kasugai
- Department of Emergency and Critical Care Medicine, Nagoya University Graduate School of Medicine Faculty of Medicine, Nagoya, Aichi, Japan
| | - Matsuoka Ayaka
- Department of Emergency and Critical Care Medicine Faculty, Saga University Hospital, Saga, Saga, Japan
| | - Kenji Oike
- Department of Rehabilitation, Tsuchiura Kyodo General Hospital, Tsuchiura, Japan
| | | | - Kunihiko Takahashi
- M & D Data Science Center, Tokyo Medical and Dental University, Bunkyo-ku, Tokyo, Japan
| | | | - Takayuki Ogura
- Department of Emergency Medicine and Critical Care Medicine, Tochigi prefectural emergency and critical care center, Saiseikai Utsunomiya Hospital, Utsunomiya, Tochigi, Japan
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Tagami T, Yamakawa K, Endo A, Hayakawa M, Ogura T, Hirayama A, Yasunaga H. Japanese Multicenter Research of COVID-19 by Assembling Real-world Data: A Study Protocol. Ann Clin Epidemiol 2022; 4:92-100. [PMID: 38504944 PMCID: PMC10760490 DOI: 10.37737/ace.22012] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/08/2021] [Accepted: 01/16/2022] [Indexed: 03/21/2024]
Abstract
BACKGROUND Data on the evaluation of the clinical course of coronavirus disease 2019 (COVID-19) and the efficacy of treatments after hospitalization in Japan are limited. OBJECTIVE This study aimed to construct a database of confirmed COVID-19 cases in Japan and promptly address unresolved research issues. METHODS This multicenter observational study included patients who had a laboratory-confirmed severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection and were discharged from each participating institution between January 1 and September 31, 2020. We called for participating facilities and research proposals until the end of September 2020. The research steering committee members provided advice to co-investigators on refining their research proposals and analyses. After developing the research proposal, we collected clinical information, facility information, and laboratory data from each participating institution. Clinical information was also obtained from the Diagnosis Procedure Combination (DPC) data using a dedicated software called DPC hash application. ANALYSIS We planned to conduct an analysis based on the research proposal. Overall, 66 institutions from Japan announced their participation, and 102 research proposals were selected for the analyses. Research areas from the proposals included epidemiology, pathophysiology, therapeutic agents, ventilator settings, cost-benefit analyses, and prognosis prediction for COVID-19. CONTRIBUTION AND SIGNIFICANCE TO THE FIELD We have established an efficient data collection system and clinical research team for COVID-19 infection studies. The results of this study may be utilized in future response strategies for COVID-19.
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Affiliation(s)
- Takashi Tagami
- Department of Emergency and Critical Care Medicine, Nippon Medical School Musashikosugi Hospital
- Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo
| | - Kazuma Yamakawa
- Department of Emergency Medicine, Osaka Medical and Pharmaceutical University
| | - Akira Endo
- Trauma and Acute Critical Care Center, Tokyo Medical and Dental University Hospital
| | - Mineji Hayakawa
- Department of Emergency Medicine, Hokkaido University Hospital
| | - Takayuki Ogura
- Department of Emergency Medicine and Critical Care Medicine, Tochigi Prefectural Emergency and Critical Care Centre, Imperial Foundation Saiseikai Utsunomiya Hospital
| | - Atsushi Hirayama
- Public Health, Department of Social Medicine, Graduate School of Medicine, Osaka University
| | - Hideo Yasunaga
- Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo
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Almeland SK, Hughes A, Leclerc T, Ogura T, Hayashi M, Mills JA, Norton I, Potokar T. "Reply: Letter to the Editor on recommendations for burns care in mass casualty incidents: WHO Emergency Medical Teams Technical Working Group on Burns (WHO TWGB) 2017-2020.". Burns 2022; 48:482-484. [PMID: 34903407 DOI: 10.1016/j.burns.2021.11.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Accepted: 11/04/2021] [Indexed: 12/14/2022]
Affiliation(s)
- Stian Kreken Almeland
- Department of Plastic, Hand and Reconstructive Surgery, Norwegian National Burn Center, Haukeland University Hospital, Bergen, Norway; Department of Clinical Medicine, Faculty of Medicine, University of Bergen, Norway.
| | - Amy Hughes
- Interburns, International Network for Training, Education and Research in Burns, Swansea, Wales, UK; Humanitarian and Conflict Response Institute (HCRI), University of Manchester, UK; Cambridge Hospital NHS Foundation Trust (Addenbrookes), Paediatric ICU Department, UK.
| | - Thomas Leclerc
- Burn Centre, Percy Military Teaching Hospital, Clamart, France; Val-de-Grâce Military Medical Academy, Paris, France.
| | - Takayuki Ogura
- Tochigi Emergency and Critical Care Centre, Imperial Foundation Saiseikai, Utsunomiya Hospital, Japan.
| | - Minoru Hayashi
- St.Mary's Hospital, Department of Plastic and Reconstructive Surgery, Japan.
| | - Jody-Anne Mills
- Rehabilitation Programme, Department of NCD, World Health Organization, Geneva, Switzerland.
| | - Ian Norton
- World Health Organization (2014-2019), Geneva, Switzerland; Respond Global, Australia.
| | - Tom Potokar
- Interburns, International Network for Training, Education and Research in Burns, Swansea, Wales, UK; Centre for Global Burn Injury Policy and Research, Swansea University, Wales, UK; World Health Organization, Emergency Medical Teams Technical Working Group on Burns, Switzerland.
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Fujimori R, Liu K, Soeno S, Naraba H, Ogura K, Hara K, Sonoo T, Ogura T, Nakamura K, Goto T. Acceptance, barriers and facilitators to implementing AI-based decision support systems in emergency departments: a quantitative and qualitative evaluation (Preprint). JMIR Form Res 2022; 6:e36501. [PMID: 35699995 PMCID: PMC9237770 DOI: 10.2196/36501] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2022] [Revised: 04/13/2022] [Accepted: 05/08/2022] [Indexed: 01/22/2023] Open
Abstract
Background Despite the increasing availability of clinical decision support systems (CDSSs) and rising expectation for CDSSs based on artificial intelligence (AI), little is known about the acceptance of AI-based CDSS by physicians and its barriers and facilitators in emergency care settings. Objective We aimed to evaluate the acceptance, barriers, and facilitators to implementing AI-based CDSSs in the emergency care setting through the opinions of physicians on our newly developed, real-time AI-based CDSS, which alerts ED physicians by predicting aortic dissection based on numeric and text information from medical charts, by using the Unified Theory of Acceptance and Use of Technology (UTAUT; for quantitative evaluation) and the Consolidated Framework for Implementation Research (CFIR; for qualitative evaluation) frameworks. Methods This mixed methods study was performed from March to April 2021. Transitional year residents (n=6), emergency medicine residents (n=5), and emergency physicians (n=3) from two community, tertiary care hospitals in Japan were included. We first developed a real-time CDSS for predicting aortic dissection based on numeric and text information from medical charts (eg, chief complaints, medical history, vital signs) with natural language processing. This system was deployed on the internet, and the participants used the system with clinical vignettes of model cases. Participants were then involved in a mixed methods evaluation consisting of a UTAUT-based questionnaire with a 5-point Likert scale (quantitative) and a CFIR-based semistructured interview (qualitative). Cronbach α was calculated as a reliability estimate for UTAUT subconstructs. Interviews were sampled, transcribed, and analyzed using the MaxQDA software. The framework analysis approach was used during the study to determine the relevance of the CFIR constructs. Results All 14 participants completed the questionnaires and interviews. Quantitative analysis revealed generally positive responses for user acceptance with all scores above the neutral score of 3.0. In addition, the mixed methods analysis identified two significant barriers (System Performance, Compatibility) and two major facilitators (Evidence Strength, Design Quality) for implementation of AI-based CDSSs in emergency care settings. Conclusions Our mixed methods evaluation based on theoretically grounded frameworks revealed the acceptance, barriers, and facilitators of implementation of AI-based CDSS. Although the concern of system failure and overtrusting of the system could be barriers to implementation, the locality of the system and designing an intuitive user interface could likely facilitate the use of optimal AI-based CDSS. Alleviating and resolving these factors should be key to achieving good user acceptance of AI-based CDSS.
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Affiliation(s)
- Ryo Fujimori
- Faculty of Medicine, The University of Tokyo, Tokyo, Japan
- TXP Medical Co Ltd, Tokyo, Japan
| | - Keibun Liu
- TXP Medical Co Ltd, Tokyo, Japan
- Critical Care Research Group, The Prince Charles Hospital, Brisbane, Australia
| | - Shoko Soeno
- TXP Medical Co Ltd, Tokyo, Japan
- Department of Palliative Care, Southern Tohoku General Hospital, Fukushima, Japan
| | - Hiromu Naraba
- TXP Medical Co Ltd, Tokyo, Japan
- Department of Emergency and Critical Care Medicine, Hitachi General Hospital, Ibaraki, Japan
| | - Kentaro Ogura
- Faculty of Medicine, The University of Tokyo, Tokyo, Japan
- TXP Medical Co Ltd, Tokyo, Japan
| | - Konan Hara
- TXP Medical Co Ltd, Tokyo, Japan
- Department of Economics, University of Arizona, Tucson, AZ, United States
| | - Tomohiro Sonoo
- TXP Medical Co Ltd, Tokyo, Japan
- Department of Emergency and Critical Care Medicine, Hitachi General Hospital, Ibaraki, Japan
| | - Takayuki Ogura
- Department of Emergency and Critical Care Medicine, Saiseikai Utsunomiya Hospital, Tochigi, Japan
| | - Kensuke Nakamura
- Department of Emergency and Critical Care Medicine, Hitachi General Hospital, Ibaraki, Japan
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Sasaki J, Matsushima A, Ikeda H, Inoue Y, Katahira J, Kishibe M, Kimura C, Sato Y, Takuma K, Tanaka K, Hayashi M, Matsumura H, Yasuda H, Yoshimura Y, Aoki H, Ishizaki Y, Isono N, Ueda T, Umezawa K, Osuka A, Ogura T, Kaita Y, Kawai K, Kawamoto K, Kimura M, Kubo T, Kurihara T, Kurokawa M, Kobayashi S, Saitoh D, Shichinohe R, Shibusawa T, Suzuki Y, Soejima K, Hashimoto I, Fujiwara O, Matsuura H, Miida K, Miyazaki M, Murao N, Morikawa W, Yamada S. Japanese Society for Burn Injuries (JSBI) Clinical Practice Guidelines for Management of Burn Care (3rd Edition). Acute Med Surg 2022; 9:e739. [PMID: 35493773 PMCID: PMC9045063 DOI: 10.1002/ams2.739] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Revised: 01/29/2022] [Accepted: 02/03/2022] [Indexed: 01/28/2023] Open
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Abbas A, Abdukahil SA, Abdulkadir NN, Abe R, Abel L, Absil L, Acharya S, Acker A, Adachi S, Adam E, Adrião D, Ageel SA, Ahmed S, Ain Q, Ainscough K, Aisa T, Ait Hssain A, Ait Tamlihat Y, Akimoto T, Akmal E, Al Qasim E, Alalqam R, Alam T, Al-dabbous T, Alegesan S, Alegre C, Alessi M, Alex B, Alexandre K, Al-Fares A, Alfoudri H, Ali I, Ali Shah N, Alidjnou KE, Aliudin J, Alkhafajee Q, Allavena C, Allou N, Altaf A, Alves J, Alves JM, Alves R, Amaral M, Amira N, Ammerlaan H, Ampaw P, Andini R, Andrejak C, Angheben A, Angoulvant F, Ansart S, Anthonidass S, Antonelli M, Antunes de Brito CA, Anwar KR, Apriyana A, Arabi Y, Aragao I, Arali R, Arancibia F, Araujo C, Arcadipane A, Archambault P, Arenz L, Arlet JB, Arnold-Day C, Aroca A, Arora L, Arora R, Artaud-Macari E, Aryal D, Asaki M, Asensio A, Ashley E, Ashraf M, Ashraf S, Asim M, Assie JB, Asyraf A, Atique A, Attanyake AMUL, Auchabie J, Aumaitre H, Auvet A, Azemar L, Azoulay C, Bach B, Bachelet D, Badr C, Baig N, Baillie JK, Baird JK, Bak E, Bakakos A, Bakar NA, Bal A, Balakrishnan M, Balan V, Bani-Sadr F, Barbalho R, Barbosa NY, Barclay WS, Barnett SU, Barnikel M, Barrasa H, Barrelet A, Barrigoto C, Bartoli M, Bartone C, Baruch J, Bashir M, Basmaci R, Basri MFH, Bastos D, Battaglini D, Bauer J, Bautista Rincon DF, Bazan Dow D, Bedossa A, Bee KH, Behilill S, Beishuizen A, Beljantsev A, Bellemare D, Beltrame A, Beltrão BA, Beluze M, Benech N, Benjiman LE, Benkerrou D, Bennett S, Bento L, Berdal JE, Bergeaud D, Bergin H, Bernal Sobrino JL, Bertoli G, Bertolino L, Bessis S, Betz A, Bevilcaqua S, Bezulier K, Bhatt A, Bhavsar K, Bianchi I, Bianco C, Bidin FN, Bikram Singh M, Bin Humaid F, Bin Kamarudin MN, Bissuel F, Biston P, Bitker L, Blanco-Schweizer P, Blier C, Bloos F, Blot M, Blumberg L, Boccia F, Bodenes L, Bogaarts A, Bogaert D, Boivin AH, Bolze PA, Bompart F, Bonfasius A, Borges D, Borie R, Bosse HM, Botelho-Nevers E, Bouadma L, Bouchaud O, Bouchez S, Bouhmani D, Bouhour D, Bouiller K, Bouillet L, Bouisse C, Boureau AS, Bourke J, Bouscambert M, Bousquet A, Bouziotis J, Boxma B, Boyer-Besseyre M, Boylan M, Bozza FA, Brack M, Braconnier A, Braga C, Brandenburger T, Brás Monteiro F, Brazzi L, Breen D, Breen P, Breen P, Brett S, Brickell K, Broadley T, Browne A, Browne S, Brozzi N, Brusse-Keizer M, Buchtele N, Buesaquillo C, Bugaeva P, Buisson M, Burhan E, Burrell A, Bustos IG, Butnaru D, Cabie A, Cabral S, Caceres E, Cadoz C, Callahan M, Calligy K, Calvache JA, Cam J, Campana V, Campbell P, Campisi J, Canepa C, Cantero M, Caraux-Paz P, Cárcel S, Cardellino CS, Cardoso F, Cardoso F, Cardoso N, Cardoso S, Carelli S, Carlier N, Carmoi T, Carney G, Carpenter C, Carqueja I, Carret MC, Carrier FM, Carroll I, Carson G, Carton E, Casanova ML, Cascão M, Casey S, Casimiro J, Cassandra B, Castañeda S, Castanheira N, Castor-Alexandre G, Castrillón H, Castro I, Catarino A, Catherine FX, Cattaneo P, Cavalin R, Cavalli GG, Cavayas A, Ceccato A, Cervantes-Gonzalez M, Chair A, Chakveatze C, Chan A, Chand M, Chantalat Auger C, Chapplain JM, Chas J, Chaudary M, Chávez Iñiguez JS, Chen A, Chen YS, Cheng MP, Cheret A, Chiarabini T, Chica J, Chidambaram SK, Chin-Tho L, Chirouze C, Chiumello D, Cho HJ, Cho SM, Cholley B, Chopin MC, Chow TS, Chow YP, Chua HJ, Chua J, Cidade JP, Cisneros Herreros JM, Citarella BW, Ciullo A, Clarke E, Clarke J, Claure Del Granado R, Clohisey S, Cobb JP, Coca N, Codan C, Cody C, Coelho A, Coles M, Colin G, Collins M, Colombo SM, Combs P, Connolly J, Connor M, Conrad A, Contreras S, Conway E, Cooke GS, Copland M, Cordel H, Corley A, Cormican S, Cornelis S, Cornet AD, Corpuz AJ, Cortegiani A, Corvaisier G, Costigan E, Couffignal C, Couffin-Cadiergues S, Courtois R, Cousse S, Cregan R, Crepy D'Orleans C, Croonen S, Crowl G, Crump J, Cruz C, Cruz Berm JL, Cruz Rojo J, Csete M, Cucino A, Cullen A, Cullen C, Cummings M, Curley G, Curlier E, Curran C, Custodio P, da Silva Filipe A, Da Silveira C, Dabaliz AA, Dagens A, Dahly D, Dalton H, Dalton J, Daly S, D'Amico F, Daneman N, Daniel C, Dankwa EA, Dantas J, D’Aragon F, de Boer M, de Loughry G, de Mendoza D, De Montmollin E, de Oliveira França RF, de Pinho Oliveira AI, De Rosa R, de Silva T, de Vries P, Deacon J, Dean D, Debard A, DeBenedictis B, Debray MP, DeCastro N, Dechert W, Deconninck L, Decours R, Defous E, Delacroix I, Delaveuve E, Delavigne K, Delfos NM, Deligiannis I, Dell'Amore A, Delmas C, Delobel P, Delsing C, Demonchy E, Denis E, Deplanque D, Depuydt P, Desai M, Descamps D, Desvallée M, Dewayanti S, Diallo A, Diamantis S, Dias A, Diaz P, Diaz R, Diaz Diaz JJ, Didier K, Diehl JL, Dieperink W, Dimet J, Dinot V, Diop F, Diouf A, Dishon Y, Dixit D, Djossou F, Docherty AB, Doherty H, Dondorp AM, Dong A, Donnelly CA, Donnelly M, Donohue C, Donohue S, Donohue Y, Doran C, Doran P, Dorival C, D'Ortenzio E, Douglas JJ, Douma R, Dournon N, Downer T, Downey J, Downing M, Drake T, Driscoll A, Dryden M, Duarte Fonseca C, Dubee V, Dubos F, Ducancelle A, Duculan T, Dudman S, Duggal A, Dunand P, Dunning J, 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Egi M, Ogura H, Yatabe T, Atagi K, Inoue S, Iba T, Kakihana Y, Kawasaki T, Kushimoto S, Kuroda Y, Kotani J, Shime N, Taniguchi T, Tsuruta R, Doi K, Doi M, Nakada TA, Nakane M, Fujishima S, Hosokawa N, Masuda Y, Matsushima A, Matsuda N, Yamakawa K, Hara Y, Sakuraya M, Ohshimo S, Aoki Y, Inada M, Umemura Y, Kawai Y, Kondo Y, Saito H, Taito S, Takeda C, Terayama T, Tohira H, Hashimoto H, Hayashida K, Hifumi T, Hirose T, Fukuda T, Fujii T, Miura S, Yasuda H, Abe T, Andoh K, Iida Y, Ishihara T, Ide K, Ito K, Ito Y, Inata Y, Utsunomiya A, Unoki T, Endo K, Ouchi A, Ozaki M, Ono S, Katsura M, Kawaguchi A, Kawamura Y, Kudo D, Kubo K, Kurahashi K, Sakuramoto H, Shimoyama A, Suzuki T, Sekine S, Sekino M, Takahashi N, Takahashi S, Takahashi H, Tagami T, Tajima G, Tatsumi H, Tani M, Tsuchiya A, Tsutsumi Y, Naito T, Nagae M, Nagasawa I, Nakamura K, Nishimura T, Nunomiya S, Norisue Y, Hashimoto S, Hasegawa D, Hatakeyama J, Hara N, Higashibeppu N, Furushima N, Furusono H, Matsuishi Y, Matsuyama T, Minematsu Y, Miyashita R, Miyatake Y, Moriyasu M, Yamada T, Yamada H, Yamamoto R, Yoshida T, Yoshida Y, Yoshimura J, Yotsumoto R, Yonekura H, Wada T, Watanabe E, Aoki M, Asai H, Abe T, Igarashi Y, Iguchi N, Ishikawa M, Ishimaru G, Isokawa S, Itakura R, Imahase H, Imura H, Irinoda T, Uehara K, Ushio N, Umegaki T, Egawa Y, Enomoto Y, Ota K, Ohchi Y, Ohno T, Ohbe H, Oka K, Okada N, Okada Y, Okano H, Okamoto J, Okuda H, Ogura T, Onodera Y, Oyama Y, Kainuma M, Kako E, Kashiura M, Kato H, Kanaya A, Kaneko T, Kanehata K, Kano KI, Kawano H, Kikutani K, Kikuchi H, Kido T, Kimura S, Koami H, Kobashi D, Saiki I, Sakai M, Sakamoto A, Sato T, Shiga Y, Shimoto M, Shimoyama S, Shoko T, Sugawara Y, Sugita A, Suzuki S, Suzuki Y, Suhara T, Sonota K, Takauji S, Takashima K, Takahashi S, Takahashi Y, Takeshita J, Tanaka Y, Tampo A, Tsunoyama T, Tetsuhara K, Tokunaga K, Tomioka Y, Tomita K, Tominaga N, Toyosaki M, Toyoda Y, Naito H, Nagata I, Nagato T, Nakamura Y, Nakamori Y, Nahara I, Naraba H, Narita C, Nishioka N, Nishimura T, Nishiyama K, Nomura T, Haga T, Hagiwara Y, Hashimoto K, Hatachi T, Hamasaki T, Hayashi T, Hayashi M, Hayamizu A, Haraguchi G, Hirano Y, Fujii R, Fujita M, Fujimura N, Funakoshi H, Horiguchi M, Maki J, Masunaga N, Matsumura Y, Mayumi T, Minami K, Miyazaki Y, Miyamoto K, Murata T, Yanai M, Yano T, Yamada K, Yamada N, Yamamoto T, Yoshihiro S, Tanaka H, Nishida O. The Japanese Clinical Practice Guidelines for Management of Sepsis and Septic Shock 2020 (J-SSCG 2020). J Intensive Care 2021; 9:53. [PMID: 34433491 PMCID: PMC8384927 DOI: 10.1186/s40560-021-00555-7] [Citation(s) in RCA: 77] [Impact Index Per Article: 25.7] [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: 04/26/2021] [Accepted: 05/10/2021] [Indexed: 02/08/2023] Open
Abstract
The Japanese Clinical Practice Guidelines for Management of Sepsis and Septic Shock 2020 (J-SSCG 2020), a Japanese-specific set of clinical practice guidelines for sepsis and septic shock created as revised from J-SSCG 2016 jointly by the Japanese Society of Intensive Care Medicine and the Japanese Association for Acute Medicine, was first released in September 2020 and published in February 2021. An English-language version of these guidelines was created based on the contents of the original Japanese-language version. The purpose of this guideline is to assist medical staff in making appropriate decisions to improve the prognosis of patients undergoing treatment for sepsis and septic shock. We aimed to provide high-quality guidelines that are easy to use and understand for specialists, general clinicians, and multidisciplinary medical professionals. J-SSCG 2016 took up new subjects that were not present in SSCG 2016 (e.g., ICU-acquired weakness [ICU-AW], post-intensive care syndrome [PICS], and body temperature management). The J-SSCG 2020 covered a total of 22 areas with four additional new areas (patient- and family-centered care, sepsis treatment system, neuro-intensive treatment, and stress ulcers). A total of 118 important clinical issues (clinical questions, CQs) were extracted regardless of the presence or absence of evidence. These CQs also include those that have been given particular focus within Japan. This is a large-scale guideline covering multiple fields; thus, in addition to the 25 committee members, we had the participation and support of a total of 226 members who are professionals (physicians, nurses, physiotherapists, clinical engineers, and pharmacists) and medical workers with a history of sepsis or critical illness. The GRADE method was adopted for making recommendations, and the modified Delphi method was used to determine recommendations by voting from all committee members.As a result, 79 GRADE-based recommendations, 5 Good Practice Statements (GPS), 18 expert consensuses, 27 answers to background questions (BQs), and summaries of definitions and diagnosis of sepsis were created as responses to 118 CQs. We also incorporated visual information for each CQ according to the time course of treatment, and we will also distribute this as an app. The J-SSCG 2020 is expected to be widely used as a useful bedside guideline in the field of sepsis treatment both in Japan and overseas involving multiple disciplines.
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Affiliation(s)
- Moritoki Egi
- Department of Surgery Related, Division of Anesthesiology, Kobe University Graduate School of Medicine, Kusunoki-cho 7-5-2, Chuo-ku, Kobe, Hyogo, Japan.
| | - Hiroshi Ogura
- Department of Traumatology and Acute Critical Medicine, Osaka University Medical School, Yamadaoka 2-15, Suita, Osaka, Japan.
| | - Tomoaki Yatabe
- Department of Anesthesiology and Critical Care Medicine, Fujita Health University School of Medicine, Toyoake, Japan
| | - Kazuaki Atagi
- Department of Intensive Care Unit, Nara Prefectural General Medical Center, Nara, Japan
| | - Shigeaki Inoue
- Department of Disaster and Emergency Medicine, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Toshiaki Iba
- Department of Emergency and Disaster Medicine, Juntendo University, Tokyo, Japan
| | - Yasuyuki Kakihana
- Department of Emergency and Intensive Care Medicine, Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima, Japan
| | - Tatsuya Kawasaki
- Department of Pediatric Critical Care, Shizuoka Children's Hospital, Shizuoka, Japan
| | - Shigeki Kushimoto
- Division of Emergency and Critical Care Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Yasuhiro Kuroda
- Department of Emergency, Disaster, and Critical Care Medicine, Faculty of Medicine, Kagawa University, Kagawa, Japan
| | - Joji Kotani
- Department of Surgery Related, Division of Disaster and Emergency Medicine, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Nobuaki Shime
- Department of Emergency and Critical Care Medicine, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Takumi Taniguchi
- Department of Anesthesiology and Intensive Care Medicine, Kanazawa University, Kanazawa, Japan
| | - Ryosuke Tsuruta
- Acute and General Medicine, Yamaguchi University Graduate School of Medicine, Ube, Japan
| | - Kent Doi
- Department of Acute Medicine, The University of Tokyo, Tokyo, Japan
| | - Matsuyuki Doi
- Department of Anesthesiology and Intensive Care Medicine, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Taka-Aki Nakada
- Department of Emergency and Critical Care Medicine, Chiba University Graduate School of Medicine, Chiba, Japan
| | - Masaki Nakane
- Department of Emergency and Critical Care Medicine, Yamagata University Hospital, Yamagata, Japan
| | - Seitaro Fujishima
- Center for General Medicine Education, Keio University School of Medicine, Tokyo, Japan
| | - Naoto Hosokawa
- Department of Infectious Diseases, Kameda Medical Center, Kamogawa, Japan
| | - Yoshiki Masuda
- Department of Intensive Care Medicine, Sapporo Medical University School of Medicine, Sapporo, Japan
| | - Asako Matsushima
- Department of Advancing Acute Medicine, Graduate School of Medical Sciences, Nagoya City University, Nagoya, Japan
| | - Naoyuki Matsuda
- Department of Emergency and Critical Care Medicine, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Kazuma Yamakawa
- Department of Emergency Medicine, Osaka Medical College, Osaka, Japan
| | - Yoshitaka Hara
- Department of Anesthesiology and Critical Care Medicine, Fujita Health University School of Medicine, Toyoake, Japan
| | - Masaaki Sakuraya
- Department of Emergency and Intensive Care Medicine, JA Hiroshima General Hospital, Hatsukaichi, Japan
| | - Shinichiro Ohshimo
- Department of Emergency and Critical Care Medicine, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Yoshitaka Aoki
- Department of Anesthesiology and Intensive Care Medicine, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Mai Inada
- Member of Japanese Association for Acute Medicine, Tokyo, Japan
| | - Yutaka Umemura
- Division of Trauma and Surgical Critical Care, Osaka General Medical Center, Osaka, Japan
| | - Yusuke Kawai
- Department of Nursing, Fujita Health University Hospital, Toyoake, Japan
| | - Yutaka Kondo
- Department of Emergency and Critical Care Medicine, Juntendo University Urayasu Hospital, Urayasu, Japan
| | - Hiroki Saito
- Department of Emergency and Critical Care Medicine, St. Marianna University School of Medicine, Yokohama City Seibu Hospital, Yokohama, Japan
| | - Shunsuke Taito
- Division of Rehabilitation, Department of Clinical Support and Practice, Hiroshima University Hospital, Hiroshima, Japan
| | - Chikashi Takeda
- Department of Anesthesia, Kyoto University Hospital, Kyoto, Japan
| | - Takero Terayama
- Department of Psychiatry, School of Medicine, National Defense Medical College, Tokorozawa, Japan
| | | | - Hideki Hashimoto
- Department of Emergency and Critical Care Medicine/Infectious Disease, Hitachi General Hospital, Hitachi, Japan
| | - Kei Hayashida
- The Feinstein Institute for Medical Research, Manhasset, NY, USA
| | - Toru Hifumi
- Department of Emergency and Critical Care Medicine, St. Luke's International Hospital, Tokyo, Japan
| | - Tomoya Hirose
- Emergency and Critical Care Medical Center, Osaka Police Hospital, Osaka, Japan
| | - Tatsuma Fukuda
- Department of Emergency and Critical Care Medicine, Graduate School of Medicine, University of the Ryukyus, Okinawa, Japan
| | - Tomoko Fujii
- Intensive Care Unit, Jikei University Hospital, Tokyo, Japan
| | - Shinya Miura
- The Royal Children's Hospital Melbourne, Melbourne, Australia
| | - Hideto Yasuda
- Department of Emergency and Critical Care Medicine, Jichi Medical University Saitama Medical Center, Saitama, Japan
| | - Toshikazu Abe
- Department of Emergency and Critical Care Medicine, Tsukuba Memorial Hospital, Tsukuba, Japan
| | - Kohkichi Andoh
- Division of Anesthesiology, Division of Intensive Care, Division of Emergency and Critical Care, Sendai City Hospital, Sendai, Japan
| | - Yuki Iida
- Department of Physical Therapy, School of Health Sciences, Toyohashi Sozo University, Toyohashi, Japan
| | - Tadashi Ishihara
- Department of Emergency and Critical Care Medicine, Juntendo University Urayasu Hospital, Urayasu, Japan
| | - Kentaro Ide
- Critical Care Medicine, National Center for Child Health and Development, Tokyo, Japan
| | - Kenta Ito
- Department of General Pediatrics, Aichi Children's Health and Medical Center, Obu, Japan
| | - Yusuke Ito
- Department of Infectious Disease, Hyogo Prefectural Amagasaki General Medical Center, Amagasaki, Japan
| | - Yu Inata
- Department of Intensive Care Medicine, Osaka Women's and Children's Hospital, Izumi, Japan
| | - Akemi Utsunomiya
- Human Health Science, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Takeshi Unoki
- Department of Acute and Critical Care Nursing, School of Nursing, Sapporo City University, Sapporo, Japan
| | - Koji Endo
- Department of Pharmacoepidemiology, Kyoto University Graduate School of Medicine and Public Health, Kyoto, Japan
| | - Akira Ouchi
- College of Nursing, Ibaraki Christian University, Hitachi, Japan
| | - Masayuki Ozaki
- Department of Emergency and Critical Care Medicine, Komaki City Hospital, Komaki, Japan
| | - Satoshi Ono
- Gastroenterological Center, Shinkuki General Hospital, Kuki, Japan
| | | | | | - Yusuke Kawamura
- Department of Rehabilitation, Showa General Hospital, Tokyo, Japan
| | - Daisuke Kudo
- Division of Emergency and Critical Care Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Kenji Kubo
- Department of Emergency Medicine and Department of Infectious Diseases, Japanese Red Cross Wakayama Medical Center, Wakayama, Japan
| | - Kiyoyasu Kurahashi
- Department of Anesthesiology and Intensive Care Medicine, International University of Health and Welfare School of Medicine, Narita, Japan
| | | | - Akira Shimoyama
- Department of Emergency and Critical Care Medicine, Jichi Medical University Saitama Medical Center, Saitama, Japan
| | - Takeshi Suzuki
- Department of Anesthesiology, Tokai University School of Medicine, Isehara, Japan
| | - Shusuke Sekine
- Department of Anesthesiology, Tokyo Medical University, Tokyo, Japan
| | - Motohiro Sekino
- Division of Intensive Care, Nagasaki University Hospital, Nagasaki, Japan
| | - Nozomi Takahashi
- Department of Emergency and Critical Care Medicine, Chiba University Graduate School of Medicine, Chiba, Japan
| | - Sei Takahashi
- Center for Innovative Research for Communities and Clinical Excellence (CiRC2LE), Fukushima Medical University, Fukushima, Japan
| | - Hiroshi Takahashi
- Department of Cardiology, Steel Memorial Muroran Hospital, Muroran, Japan
| | - Takashi Tagami
- Department of Emergency and Critical Care Medicine, Nippon Medical School Musashi Kosugi Hospital, Kawasaki, Japan
| | - Goro Tajima
- Nagasaki University Hospital Acute and Critical Care Center, Nagasaki, Japan
| | - Hiroomi Tatsumi
- Department of Intensive Care Medicine, Sapporo Medical University School of Medicine, Sapporo, Japan
| | - Masanori Tani
- Division of Critical Care Medicine, Saitama Children's Medical Center, Saitama, Japan
| | - Asuka Tsuchiya
- Department of Emergency and Critical Care Medicine, National Hospital Organization Mito Medical Center, Ibaraki, Japan
| | - Yusuke Tsutsumi
- Department of Emergency and Critical Care Medicine, National Hospital Organization Mito Medical Center, Ibaraki, Japan
| | - Takaki Naito
- Department of Emergency and Critical Care Medicine, St. Marianna University School of Medicine, Kawasaki, Japan
| | - Masaharu Nagae
- Department of Intensive Care Medicine, Kobe University Hospital, Kobe, Japan
| | | | - Kensuke Nakamura
- Department of Emergency and Critical Care Medicine, Hitachi General Hospital, Hitachi, Japan
| | - Tetsuro Nishimura
- Department of Traumatology and Critical Care Medicine, Osaka City University Graduate School of Medicine, Osaka, Japan
| | - Shin Nunomiya
- Department of Anesthesiology and Intensive Care Medicine, Division of Intensive Care, Jichi Medical University School of Medicine, Shimotsuke, Japan
| | - Yasuhiro Norisue
- Department of Emergency and Critical Care Medicine, Tokyo Bay Urayasu Ichikawa Medical Center, Urayasu, Japan
| | - Satoru Hashimoto
- Department of Anesthesiology and Intensive Care Medicine, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Daisuke Hasegawa
- Department of Anesthesiology and Critical Care Medicine, Fujita Health University School of Medicine, Toyoake, Japan
| | - Junji Hatakeyama
- Department of Emergency and Critical Care Medicine, National Hospital Organization Tokyo Medical Center, Tokyo, Japan
| | - Naoki Hara
- Department of Pharmacy, Yokohama Rosai Hospital, Yokohama, Japan
| | - Naoki Higashibeppu
- Department of Anesthesiology and Nutrition Support Team, Kobe City Medical Center General Hospital, Kobe City Hospital Organization, Kobe, Japan
| | - Nana Furushima
- Department of Anesthesiology, Kobe University Hospital, Kobe, Japan
| | - Hirotaka Furusono
- Department of Rehabilitation, University of Tsukuba Hospital/Exult Co., Ltd., Tsukuba, Japan
| | - Yujiro Matsuishi
- Doctoral program in Clinical Sciences. Graduate School of Comprehensive Human Sciences, University of Tsukuba, Tsukuba, Japan
| | - Tasuku Matsuyama
- Department of Emergency Medicine, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Yusuke Minematsu
- Department of Clinical Engineering, Osaka University Hospital, Suita, Japan
| | - Ryoichi Miyashita
- Department of Intensive Care Medicine, Showa University School of Medicine, Tokyo, Japan
| | - Yuji Miyatake
- Department of Clinical Engineering, Kakogawa Central City Hospital, Kakogawa, Japan
| | - Megumi Moriyasu
- Division of Respiratory Care and Rapid Response System, Intensive Care Center, Kitasato University Hospital, Sagamihara, Japan
| | - Toru Yamada
- Department of Nursing, Toho University Omori Medical Center, Tokyo, Japan
| | - Hiroyuki Yamada
- Department of Primary Care and Emergency Medicine, Kyoto University Hospital, Kyoto, Japan
| | - Ryo Yamamoto
- Department of Emergency and Critical Care Medicine, Keio University School of Medicine, Tokyo, Japan
| | - Takeshi Yoshida
- Department of Anesthesiology and Intensive Care Medicine, Osaka University Graduate School of Medicine, Suita, Japan
| | - Yuhei Yoshida
- Nursing Department, Osaka General Medical Center, Osaka, Japan
| | - Jumpei Yoshimura
- Division of Trauma and Surgical Critical Care, Osaka General Medical Center, Osaka, Japan
| | | | - Hiroshi Yonekura
- Department of Clinical Anesthesiology, Mie University Hospital, Tsu, Japan
| | - Takeshi Wada
- Department of Anesthesiology and Critical Care Medicine, Division of Acute and Critical Care Medicine, Hokkaido University Faculty of Medicine, Sapporo, Japan
| | - Eizo Watanabe
- Department of Emergency and Critical Care Medicine, Eastern Chiba Medical Center, Togane, Japan
| | - Makoto Aoki
- Department of Emergency Medicine, Gunma University Graduate School of Medicine, Maebashi, Japan
| | - Hideki Asai
- Department of Emergency and Critical Care Medicine, Nara Medical University, Kashihara, Japan
| | - Takakuni Abe
- Department of Anesthesiology and Intensive Care, Oita University Hospital, Yufu, Japan
| | - Yutaka Igarashi
- Department of Emergency and Critical Care Medicine, Nippon Medical School Hospital, Tokyo, Japan
| | - Naoya Iguchi
- Department of Anesthesiology and Intensive Care Medicine, Graduate School of Medicine, Osaka University, Suita, Japan
| | - Masami Ishikawa
- Department of Anesthesiology, Emergency and Critical Care Medicine, Kure Kyosai Hospital, Kure, Japan
| | - Go Ishimaru
- Department of General Internal Medicine, Soka Municipal Hospital, Soka, Japan
| | - Shutaro Isokawa
- Department of Emergency and Critical Care Medicine, St. Luke's International Hospital, Tokyo, Japan
| | - Ryuta Itakura
- Department of Emergency and Critical Care Medicine, Tokyo Metropolitan Children's Medical Center, Tokyo, Japan
| | - Hisashi Imahase
- Department of Biomedical Ethics, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Haruki Imura
- Department of Infectious Diseases, Rakuwakai Otowa Hospital, Kyoto, Japan
- Department of Health Informatics, School of Public Health, Kyoto University, Kyoto, Japan
| | | | - Kenji Uehara
- Department of Anesthesiology, National Hospital Organization Iwakuni Clinical Center, Iwakuni, Japan
| | - Noritaka Ushio
- Advanced Medical Emergency Department and Critical Care Center, Japan Red Cross Maebashi Hospital, Maebashi, Japan
| | - Takeshi Umegaki
- Department of Anesthesiology, Kansai Medical University, Hirakata, Japan
| | - Yuko Egawa
- Advanced Emergency and Critical Care Center, Saitama Red Cross Hospital, Saitama, Japan
| | - Yuki Enomoto
- Department of Emergency and Critical Care Medicine, University of Tsukuba, Tsukuba, Japan
| | - Kohei Ota
- Department of Emergency and Critical Care Medicine, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Yoshifumi Ohchi
- Department of Anesthesiology and Intensive Care, Oita University Hospital, Yufu, Japan
| | - Takanori Ohno
- Department of Emergency and Critical Medicine, Showa University Fujigaoka Hospital, Yokohama, Japan
| | - Hiroyuki Ohbe
- Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, Tokyo, Japan
| | | | - Nobunaga Okada
- Department of Emergency Medicine, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Yohei Okada
- Department of Primary care and Emergency medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Hiromu Okano
- Department of Anesthesiology, Kyorin University School of Medicine, Tokyo, Japan
| | - Jun Okamoto
- Department of ER, Hashimoto Municipal Hospital, Hashimoto, Japan
| | - Hiroshi Okuda
- Department of Community Medical Supports, Tohoku Medical Megabank Organization, Tohoku University, Sendai, Japan
| | - Takayuki Ogura
- Tochigi prefectural Emergency and Critical Care Center, Imperial Gift Foundation Saiseikai, Utsunomiya Hospital, Utsunomiya, Japan
| | - Yu Onodera
- Department of Anesthesiology, Faculty of Medicine, Yamagata University, Yamagata, Japan
| | - Yuhta Oyama
- Department of Internal Medicine, Dialysis Center, Kichijoji Asahi Hospital, Tokyo, Japan
| | - Motoshi Kainuma
- Anesthesiology, Emergency Medicine, and Intensive Care Division, Inazawa Municipal Hospital, Inazawa, Japan
| | - Eisuke Kako
- Department of Anesthesiology and Intensive Care Medicine, Nagoya-City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Masahiro Kashiura
- Department of Emergency and Critical Care Medicine, Jichi Medical University Saitama Medical Center, Saitama, Japan
| | - Hiromi Kato
- Department of Anesthesiology and Intensive Care Medicine, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Akihiro Kanaya
- Department of Anesthesiology, Sendai Medical Center, Sendai, Japan
| | - Tadashi Kaneko
- Emergency and Critical Care Center, Mie University Hospital, Tsu, Japan
| | - Keita Kanehata
- Advanced Medical Emergency Department and Critical Care Center, Japan Red Cross Maebashi Hospital, Maebashi, Japan
| | - Ken-Ichi Kano
- Department of Emergency Medicine, Fukui Prefectural Hospital, Fukui, Japan
| | - Hiroyuki Kawano
- Department of Gastroenterological Surgery, Onga Hospital, Fukuoka, Japan
| | - Kazuya Kikutani
- Department of Emergency and Critical Care Medicine, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Hitoshi Kikuchi
- Department of Emergency and Critical Care Medicine, Seirei Mikatahara General Hospital, Hamamatsu, Japan
| | - Takahiro Kido
- Department of Pediatrics, University of Tsukuba Hospital, Tsukuba, Japan
| | - Sho Kimura
- Division of Critical Care Medicine, Saitama Children's Medical Center, Saitama, Japan
| | - Hiroyuki Koami
- Center for Translational Injury Research, University of Texas Health Science Center at Houston, Houston, USA
| | - Daisuke Kobashi
- Advanced Medical Emergency Department and Critical Care Center, Japan Red Cross Maebashi Hospital, Maebashi, Japan
| | - Iwao Saiki
- Department of Anesthesiology, Tokyo Medical University, Tokyo, Japan
| | - Masahito Sakai
- Department of General Medicine Shintakeo Hospital, Takeo, Japan
| | - Ayaka Sakamoto
- Department of Emergency and Critical Care Medicine, University of Tsukuba Hospital, Tsukuba, Japan
| | - Tetsuya Sato
- Tohoku University Hospital Emergency Center, Sendai, Japan
| | - Yasuhiro Shiga
- Department of Orthopaedic Surgery, Center for Advanced Joint Function and Reconstructive Spine Surgery, Graduate school of Medicine, Chiba University, Chiba, Japan
| | - Manabu Shimoto
- Department of Primary care and Emergency medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Shinya Shimoyama
- Department of Pediatric Cardiology and Intensive Care, Gunma Children's Medical Center, Shibukawa, Japan
| | - Tomohisa Shoko
- Department of Emergency and Critical Care Medicine, Tokyo Women's Medical University Medical Center East, Tokyo, Japan
| | - Yoh Sugawara
- Department of Anesthesiology, Yokohama City University, Yokohama, Japan
| | - Atsunori Sugita
- Department of Acute Medicine, Division of Emergency and Critical Care Medicine, Nihon University School of Medicine, Tokyo, Japan
| | - Satoshi Suzuki
- Department of Intensive Care, Okayama University Hospital, Okayama, Japan
| | - Yuji Suzuki
- Department of Anesthesiology and Intensive Care Medicine, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Tomohiro Suhara
- Department of Anesthesiology, Keio University School of Medicine, Tokyo, Japan
| | - Kenji Sonota
- Department of Intensive Care Medicine, Miyagi Children's Hospital, Sendai, Japan
| | - Shuhei Takauji
- Department of Emergency Medicine, Asahikawa Medical University, Asahikawa, Japan
| | - Kohei Takashima
- Critical Care Medicine, National Center for Child Health and Development, Tokyo, Japan
| | - Sho Takahashi
- Department of Cardiology, Fukuyama City Hospital, Fukuyama, Japan
| | - Yoko Takahashi
- Department of General Internal Medicine, Koga General Hospital, Koga, Japan
| | - Jun Takeshita
- Department of Anesthesiology, Osaka Women's and Children's Hospital, Izumi, Japan
| | - Yuuki Tanaka
- Fukuoka Prefectural Psychiatric Center, Dazaifu Hospital, Dazaifu, Japan
| | - Akihito Tampo
- Department of Emergency Medicine, Asahikawa Medical University, Asahikawa, Japan
| | - Taichiro Tsunoyama
- Department of Emergency Medicine, Teikyo University School of Medicine, Tokyo, Japan
| | - Kenichi Tetsuhara
- Emergency and Critical Care Center, Kyushu University Hospital, Fukuoka, Japan
| | - Kentaro Tokunaga
- Department of Intensive Care Medicine, Kumamoto University Hospital, Kumamoto, Japan
| | - Yoshihiro Tomioka
- Department of Anesthesiology and Intensive Care Unit, Todachuo General Hospital, Toda, Japan
| | - Kentaro Tomita
- Department of Pediatrics, Keio University School of Medicine, Tokyo, Japan
| | - Naoki Tominaga
- Department of Emergency and Critical Care Medicine, Nippon Medical School Hospital, Tokyo, Japan
| | - Mitsunobu Toyosaki
- Department of Emergency and Critical Care Medicine, Keio University School of Medicine, Tokyo, Japan
| | - Yukitoshi Toyoda
- Department of Emergency and Critical Care Medicine, Saiseikai Yokohamashi Tobu Hospital, Yokohama, Japan
| | - Hiromichi Naito
- Department of Emergency, Critical Care, and Disaster Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Isao Nagata
- Intensive Care Unit, Yokohama City Minato Red Cross Hospital, Yokohama, Japan
| | - Tadashi Nagato
- Department of Respiratory Medicine, Tokyo Yamate Medical Center, Tokyo, Japan
| | - Yoshimi Nakamura
- Department of Emergency and Critical Care Medicine, Japanese Red Cross Kyoto Daini Hospital, Kyoto, Japan
| | - Yuki Nakamori
- Department of Clinical Anesthesiology, Mie University Hospital, Tsu, Japan
| | - Isao Nahara
- Department of Anesthesiology and Critical Care Medicine, Nagoya Daini Red Cross Hospital, Nagoya, Japan
| | - Hiromu Naraba
- Department of Emergency and Critical Care Medicine, Hitachi General Hospital, Hitachi, Japan
| | - Chihiro Narita
- Department of Emergency Medicine and Intensive Care Medicine, Shizuoka General Hospital, Shizuoka, Japan
| | - Norihiro Nishioka
- Department of Preventive Services, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Tomoya Nishimura
- Advanced Medical Emergency Department and Critical Care Center, Japan Red Cross Maebashi Hospital, Maebashi, Japan
| | - Kei Nishiyama
- Division of Emergency and Critical Care Medicine Niigata University Graduate School of Medical and Dental Science, Niigata, Japan
| | - Tomohisa Nomura
- Department of Emergency and Critical Care Medicine, Juntendo University Nerima Hospital, Tokyo, Japan
| | - Taiki Haga
- Department of Pediatric Critical Care Medicine, Osaka City General Hospital, Osaka, Japan
| | - Yoshihiro Hagiwara
- Department of Emergency and Critical Care Medicine, Saiseikai Utsunomiya Hospital, Utsunomiya, Japan
| | - Katsuhiko Hashimoto
- Research Associate of Minimally Invasive Surgical and Medical Oncology, Fukushima Medical University, Fukushima, Japan
| | - Takeshi Hatachi
- Department of Intensive Care Medicine, Osaka Women's and Children's Hospital, Izumi, Japan
| | - Toshiaki Hamasaki
- Department of Emergency Medicine, Japanese Red Cross Society Wakayama Medical Center, Wakayama, Japan
| | - Takuya Hayashi
- Division of Critical Care Medicine, Saitama Children's Medical Center, Saitama, Japan
| | - Minoru Hayashi
- Department of Emergency Medicine, Fukui Prefectural Hospital, Fukui, Japan
| | - Atsuki Hayamizu
- Department of Emergency Medicine, Saitama Saiseikai Kurihashi Hospital, Kuki, Japan
| | - Go Haraguchi
- Division of Intensive Care Unit, Sakakibara Heart Institute, Tokyo, Japan
| | - Yohei Hirano
- Department of Emergency and Critical Care Medicine, Juntendo University Urayasu Hospital, Urayasu, Japan
| | - Ryo Fujii
- Department of Emergency Medicine and Critical Care Medicine, Tochigi Prefectural Emergency and Critical Care Center, Imperial Foundation Saiseikai Utsunomiya Hospital, Utsunomiya, Japan
| | - Motoki Fujita
- Acute and General Medicine, Yamaguchi University Graduate School of Medicine, Ube, Japan
| | - Naoyuki Fujimura
- Department of Anesthesiology, St. Mary's Hospital, Our Lady of the Snow Social Medical Corporation, Kurume, Japan
| | - Hiraku Funakoshi
- Department of Emergency and Critical Care Medicine, Tokyo Bay Urayasu Ichikawa Medical Center, Urayasu, Japan
| | - Masahito Horiguchi
- Department of Emergency and Critical Care Medicine, Japanese Red Cross Kyoto Daiichi Hospital, Kyoto, Japan
| | - Jun Maki
- Department of Critical Care Medicine, Kyushu University Hospital, Fukuoka, Japan
| | - Naohisa Masunaga
- Department of Healthcare Epidemiology, School of Public Health in the Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Yosuke Matsumura
- Department of Intensive Care, Chiba Emergency Medical Center, Chiba, Japan
| | - Takuya Mayumi
- Department of Internal Medicine, Kanazawa Municipal Hospital, Kanazawa, Japan
| | - Keisuke Minami
- Ishikawa Prefectual Central Hospital Emergency and Critical Care Center, Kanazawa, Japan
| | - Yuya Miyazaki
- Department of Emergency and General Internal Medicine, Saiseikai Kawaguchi General Hospital, Kawaguchi, Japan
| | - Kazuyuki Miyamoto
- Department of Emergency and Disaster Medicine, Showa University, Tokyo, Japan
| | - Teppei Murata
- Department of Cardiology, Tokyo Metropolitan Geriatric Hospital and Institute of Gerontology, Tokyo, Japan
| | - Machi Yanai
- Department of Emergency Medicine, Kobe City Medical Center General Hospital, Kobe, Japan
| | - Takao Yano
- Department of Critical Care and Emergency Medicine, Miyazaki Prefectural Nobeoka Hospital, Nobeoka, Japan
| | - Kohei Yamada
- Department of Traumatology and Critical Care Medicine, National Defense Medical College, Tokorozawa, Japan
| | - Naoki Yamada
- Department of Emergency Medicine, University of Fukui Hospital, Fukui, Japan
| | - Tomonori Yamamoto
- Department of Intensive Care Unit, Nara Prefectural General Medical Center, Nara, Japan
| | - Shodai Yoshihiro
- Pharmaceutical Department, JA Hiroshima General Hospital, Hatsukaichi, Japan
| | - Hiroshi Tanaka
- Department of Emergency and Critical Care Medicine, Juntendo University Urayasu Hospital, Urayasu, Japan
| | - Osamu Nishida
- Department of Anesthesiology and Critical Care Medicine, Fujita Health University School of Medicine, Toyoake, Japan
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Ogura T, Hirata A, Inoue Y, Kagtagiri T, Takakura Y, Kameda H. POS1396 DAMAGE PROGRESSION OF FINGER JOINT CARTILAGE EVALUATED BY ULTRASOUND AND X-RAY IN PATIENTS WITH RHEUMATOID ARTHRITIS (RA). Ann Rheum Dis 2021. [DOI: 10.1136/annrheumdis-2021-eular.2784] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Background:Cartilage damage in RA has been evaluated by joint space narrowing (JSN) in X-ray, while it is not a direct evaluation of cartilage. Previously we have confirmed the usefulness of the direct imaging of finger joint cartilage by ultrasound (US) in patients with RA [1].Objectives:We aimed to examine the temporal changes of US cartilage thickness in RA patients.Methods:We enrolled 53 RA patients in whom the cartilage thickness of finger joints was measured by US and had radiographs of both hands at baseline and 1-year later. The cartilage of metacapophalangeal and proximal interphalangeal joints of 2nd to 5th fingers were bilaterally visualized at the middle portion from a longitudinal dorsal view. Cartilage thickness was measured from the base of the cartilage to the interface artefact at the cartilage surface by static images. In addition, the JSN of the corresponding joints was scored using a hand X-ray by van der Heijde-modified Sharp method. Continuous variables from the two groups were analyzed using the Mann-Whitney U test or Wilcoxon signed-rank test. The relationships among the continuous variables were assessed using the Spearman’s rank correlation coefficient.Results:The median age of the patients was 68 years and the median disease duration was 6.3 years. The sum of total cartilage thickness from 16 joints per patient ranged from 3.1 to 9.1mm (median 6.5 mm) at baseline, and it was significantly correlated with total JSN score of the same joints (ρ=-0.63, p<0.001). The cartilage thickness was inversely correlated with disease duration (rho=-0.40, p=0.003), but not associated with age nor height. The decrease in cartilage thickness over 1 year was evident in patients with persistent moderate to high disease activity by the DAS28-CRP (n=10; median -6.2%) as compared with other patients (n=43; median -1.2%, p=0.004 versus active patients).Conclusion:This pilot study demonstrated the progression of cartilage damage by sustained RA activity, supporting the validity and usefulness of joint cartilage thickness evaluation by ultrasound in patients with RA.References:[1]Ogura T, et al. Arthritis Care Res 2019 Oct 25.Table 1.SALIENT FEATURES OF THE 9 PATIENTS PRESENTING WITH RETINAL TOXICITY DUE TO HCQSl.NoAgeGenderWeight(Kg)Primary DiagnosisDoseDuration(Years)Detection Method UsedRecommended Dose(mg/Day)Received Dose(mg/Day)Cumulative Dose(grams)FUNDUSEXAM.SD-OCTHVF10-2FAF147F58SLE2904004383RPE ChangesThinning/Photoreceptor LossDefects seen-220F46SLE2302001462Multiple Small Drusens In Paramacular AreaMultipleDrusensNormalPerifoveal autofluorescence spots-drusens323F50SLE2504001461RPE ChangesRPEDisruptionsDefects seen-430F55SLE275200731NormalNormalParacentral Scotoma-550F49RA2452005117Early Bull’s Eye MaculopathyRPEAtrophyDefects seen-672F60RA30020073010RPE AtrophyFR AbsentRPEAtrophyGeneral reduction in sensitivity-765M57.4RA2872001462RPE ChangesRPEDisruptions & Thinning NotedDefects seen-862F70RA3502002193Chorioretinal AtrophyAlteredRPEMembraneDefects seen-959M71.6RA3582002924RPE ChangesRPEDisruptionsNormal-F:Female; M:Male; SLE:Systemic Lupus Erythematosus; RA: Rheumatoid Arthritis, FUNDUS EXAM.: Fundus Examination; SD-OCT:Spectral Domain-Optical Coherence Tomography, HVF 10-2:Humphrey Visual Field 10-2; FAF: Fundus Autofluorescence, RPE:Retinal Pigment Epithelium; FR:Foveal ReflexDisclosure of Interests:None declared
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Hifumi T, Inoue A, Takiguchi T, Watanabe K, Ogura T, Okazaki T, Ijuin S, Zushi R, Arimoto H, Takada H, Shiraishi S, Egawa Y, Kanda J, Nasu M, Kobayashi M, Sakuraya M, Naito H, Nakao S, Otani N, Takeuchi I, Bunya N, Shimizu T, Sawano H, Takayama W, Kushimoto S, Shoko T, Aoki M, Otani T, Matsuoka Y, Homma K, Maekawa K, Tahara Y, Fukuda R, Kikuchi M, Nakagami T, Hagiwara Y, Kitamura N, Sugiyama K, Sakamoto T, Kuroda Y. Variability of extracorporeal cardiopulmonary resuscitation practice in patients with out-of-hospital cardiac arrest from the emergency department to intensive care unit in Japan. Acute Med Surg 2021; 8:e647. [PMID: 33968411 PMCID: PMC8088390 DOI: 10.1002/ams2.647] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2021] [Revised: 03/17/2021] [Accepted: 03/23/2021] [Indexed: 11/14/2022] Open
Abstract
Aim A lack of known guidelines for the provision of extracorporeal cardiopulmonary resuscitation (ECPR) to patients with out‐of‐hospital cardiac arrest (OHCA) has led to variability in practice between hospitals even in the same country. Because variability in ECPR practice has not been completely examined, we aimed to describe the variability in ECPR practice in patients with OHCA from the emergency department (ED) to the intensive care units (ICU). Methods An anonymous online questionnaire to examine variability in ECPR practice was completed in January 2020 by 36 medical institutions who participated in the SAVE‐J II study. Institutional demographics, inclusion and exclusion criteria, initial resuscitation management, extracorporeal membrane oxygenation (ECMO) initiation, initial ECMO management, intra‐aortic balloon pumping/endotracheal intubation/management during coronary angiography, and computed tomography criteria were recorded. Results We received responses from all 36 institutions. Four institutions (11.1%) had a hybrid emergency room. Cardiovascular surgery was always involved throughout the entire ECMO process in only 14.7% of institutions; 60% of institutions had formal inclusion criteria and 50% had formal exclusion criteria. In two‐thirds of institutions, emergency physicians carried out cannulation. Catheterization room was the leading location of cannulation (48.6%) followed by ED (31.4%). The presence of formal exclusion criteria significantly increased with increasing ECPR volume (P for trend <0.001). Intra‐aortic balloon pumping was routinely initiated in only 25% of institutions. Computed tomography was routinely carried out before coronary angiography in 25% of institutions. Conclusions We described the variability in ECPR practice in patients with OHCA from the ED to the ICU.
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Hughes A, Almeland SK, Leclerc T, Ogura T, Hayashi M, Mills JA, Norton I, Potokar T. Recommendations for burns care in mass casualty incidents: WHO Emergency Medical Teams Technical Working Group on Burns (WHO TWGB) 2017-2020. Burns 2021; 47:349-370. [PMID: 33041154 PMCID: PMC7955277 DOI: 10.1016/j.burns.2020.07.001] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Accepted: 07/02/2020] [Indexed: 12/15/2022]
Abstract
Health and logistical needs in emergencies have been well recognised. The last 7 years has witnessed improved professionalisation and standardisation of care for disaster affected communities - led in part by the World Health Organisation Emergency Medical Team (EMT) initiative. Mass casualty incidents (MCIs) resulting in burn injuries present unique challenges. Burn management benefits from specialist skills, expert knowledge, and timely availability of specialist resources. With burn MCIs occurring globally, and wide variance in existing burn care capacity, the need to strengthen burn care capability is evident. Although some high-income countries have well-established disaster management plans, including burn specific plans, many do not - the majority of countries where burn mass casualty events occur are without such established plans. Developing globally relevant recommendations is a first step in addressing this deficit and increasing preparedness to deal with such disasters. Global burn experts were invited to a succession of Technical Working Group on burns (TWGB) meetings to: 1) review literature on burn care in MCIs; and 2) define and agree on recommendations for burn care in MCIs. The resulting 22 recommendations provide a framework to guide national and international specialist burn teams and health facilities to support delivery of safe care and improved outcomes to burn patients in MCIs.
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Affiliation(s)
- Amy Hughes
- Interburns, International Network for Training, Education and Research in Burns, Swansea, Wales, UK,Humanitarian and Conflict Response Institute (HCRI), University of Manchester, UK,Cambridge Hospital NHS Foundation Trust (Addenbrookes), Paediatric ICU Department, UK
| | - Stian Kreken Almeland
- Department of Plastic, Hand and Reconstructive Surgery, Norwegian National Burn Center, Haukeland University Hospital, Bergen, Norway,Faculty of Medicine, University of Bergen, Norway
| | - Thomas Leclerc
- Burn Centre, Percy Military Teaching Hospital, Clamart, France,Val-de-Grâce Military Medical Academy, Paris, France
| | - Takayuki Ogura
- Japanese Society for Burn Injuries, The Disaster Network Committee
| | - Minoru Hayashi
- Japanese society for burn injuries, The Academic Committee
| | - Jody-Ann Mills
- Rehabilitation Programme, Department of NCD, World Health Organization, Geneva, Switzerland
| | - Ian Norton
- World Health Organization (2013-2019), Emergency Medical Team Initiative Lead, Geneva,Respond Global, Queensland, Australia,Co-Chair World Health Organization EMT Technical Working Group on Burns, Geneva
| | - Tom Potokar
- Interburns, International Network for Training, Education and Research in Burns, Swansea, Wales, UK,Centre for Global Burn Injury Policy and Research, Swansea University, Wales, UK,Co-Chair World Health Organization EMT Technical Working Group on Burns, Geneva,Corresponding author at: Co Chair WHO-EMT Technical Working Group on Burns; Centre for Global Burn Injury Policy & Research; Swansea University; Wales; UK.
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Ravichandran S, Lee Y, Grubbs G, Coyle EM, Klenow L, Akasaka O, Koga M, Adachi E, Saito M, Nakachi I, Ogura T, Baba R, Ito M, Kiso M, Yasuhara A, Yamada S, Sakai-Tagawa Y, Iwatsuki-Horimoto K, Imai M, Yamayoshi S, Yotsuyanagi H, Kawaoka Y, Khurana S. Longitudinal antibody repertoire in "mild" versus "severe" COVID-19 patients reveals immune markers associated with disease severity and resolution. Sci Adv 2021; 7:7/10/eabf2467. [PMID: 33674317 PMCID: PMC7935365 DOI: 10.1126/sciadv.abf2467] [Citation(s) in RCA: 43] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Accepted: 01/21/2021] [Indexed: 05/05/2023]
Abstract
Limited knowledge exists on immune markers associated with disease severity or recovery in patients with coronavirus disease 2019 (COVID-19). Here, we elucidated longitudinal evolution of SARS-CoV-2 antibody repertoire in patients with acute COVID-19. Differential kinetics was observed for immunoglobulin M (IgM)/IgG/IgA epitope diversity, antibody binding, and affinity maturation in "severe" versus "mild" COVID-19 patients. IgG profile demonstrated immunodominant antigenic sequences encompassing fusion peptide and receptor binding domain (RBD) in patients with mild COVID-19 who recovered early compared with "fatal" COVID-19 patients. In patients with severe COVID-19, high-titer IgA were observed, primarily against RBD, especially in patients who succumbed to SARS-CoV-2 infection. The patients with mild COVID-19 showed marked increase in antibody affinity maturation to prefusion SARS-CoV-2 spike that associated with faster recovery from COVID-19. This study revealed antibody markers associated with disease severity and resolution of clinical disease that could inform development and evaluation of effective immune-based countermeasures against COVID-19.
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Affiliation(s)
- Supriya Ravichandran
- Division of Viral Products, Center for Biologics Evaluation and Research (CBER), FDA, Silver Spring, MD 20871, USA
| | - Youri Lee
- Division of Viral Products, Center for Biologics Evaluation and Research (CBER), FDA, Silver Spring, MD 20871, USA
| | - Gabrielle Grubbs
- Division of Viral Products, Center for Biologics Evaluation and Research (CBER), FDA, Silver Spring, MD 20871, USA
| | - Elizabeth M Coyle
- Division of Viral Products, Center for Biologics Evaluation and Research (CBER), FDA, Silver Spring, MD 20871, USA
| | - Laura Klenow
- Division of Viral Products, Center for Biologics Evaluation and Research (CBER), FDA, Silver Spring, MD 20871, USA
| | - Osamu Akasaka
- Emergency Medical Center, Fujisawa City Hospital 2-6-1 Fujisawa, Fujisawa City, Kanagawa 251-8550, Japan
| | - Michiko Koga
- Division of Infectious Diseases, Advanced Clinical Research Center, Institute of Medical Science, University of Tokyo, 4-6-1 Shirokanedai, Minato-ku, Tokyo 108-8639, Japan
| | - Eisuke Adachi
- Division of Infectious Diseases, Advanced Clinical Research Center, Institute of Medical Science, University of Tokyo, 4-6-1 Shirokanedai, Minato-ku, Tokyo 108-8639, Japan
| | - Makoto Saito
- Division of Infectious Diseases, Advanced Clinical Research Center, Institute of Medical Science, University of Tokyo, 4-6-1 Shirokanedai, Minato-ku, Tokyo 108-8639, Japan
| | - Ichiro Nakachi
- Pulmonary Division, Department of Internal Medicine, Saiseikai Utsunomiya Hospital 911-1 Takebayashimachi, Utsunomiya 321-0974, Japan
| | - Takayuki Ogura
- Department of Emergency & Intensive care, Saiseikai Utsunomiya Hospital 911-1 Takebayashimachi, Utsunomiya 321-0974, Japan
| | - Rie Baba
- Pulmonary Division, Department of Internal Medicine, Saiseikai Utsunomiya Hospital 911-1 Takebayashimachi, Utsunomiya 321-0974, Japan
| | - Mutsumi Ito
- Division of Virology, Department of Microbiology and Immunology, Institute of Medical Science, University of Tokyo, 4-6-1 Shirokanedai, Minato-ku, Tokyo 108-8639, Japan
| | - Maki Kiso
- Division of Virology, Department of Microbiology and Immunology, Institute of Medical Science, University of Tokyo, 4-6-1 Shirokanedai, Minato-ku, Tokyo 108-8639, Japan
| | - Atsuhiro Yasuhara
- Division of Virology, Department of Microbiology and Immunology, Institute of Medical Science, University of Tokyo, 4-6-1 Shirokanedai, Minato-ku, Tokyo 108-8639, Japan
| | - Shinya Yamada
- Division of Virology, Department of Microbiology and Immunology, Institute of Medical Science, University of Tokyo, 4-6-1 Shirokanedai, Minato-ku, Tokyo 108-8639, Japan
| | - Yuko Sakai-Tagawa
- Division of Virology, Department of Microbiology and Immunology, Institute of Medical Science, University of Tokyo, 4-6-1 Shirokanedai, Minato-ku, Tokyo 108-8639, Japan
| | - Kiyoko Iwatsuki-Horimoto
- Division of Virology, Department of Microbiology and Immunology, Institute of Medical Science, University of Tokyo, 4-6-1 Shirokanedai, Minato-ku, Tokyo 108-8639, Japan
| | - Masaki Imai
- Division of Virology, Department of Microbiology and Immunology, Institute of Medical Science, University of Tokyo, 4-6-1 Shirokanedai, Minato-ku, Tokyo 108-8639, Japan
| | - Seiya Yamayoshi
- Division of Virology, Department of Microbiology and Immunology, Institute of Medical Science, University of Tokyo, 4-6-1 Shirokanedai, Minato-ku, Tokyo 108-8639, Japan
| | - Hiroshi Yotsuyanagi
- Division of Infectious Diseases, Advanced Clinical Research Center, Institute of Medical Science, University of Tokyo, 4-6-1 Shirokanedai, Minato-ku, Tokyo 108-8639, Japan
| | - Yoshihiro Kawaoka
- Division of Virology, Department of Microbiology and Immunology, Institute of Medical Science, University of Tokyo, 4-6-1 Shirokanedai, Minato-ku, Tokyo 108-8639, Japan
- Influenza Research Institute, Department of Pathobiological Sciences, School of Veterinary Medicine, University of Wisconsin-Madison, Madison, WI 53711, USA
| | - Surender Khurana
- Division of Viral Products, Center for Biologics Evaluation and Research (CBER), FDA, Silver Spring, MD 20871, USA.
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Yamayoshi S, Yasuhara A, Ito M, Akasaka O, Nakamura M, Nakachi I, Koga M, Mitamura K, Yagi K, Maeda K, Kato H, Nojima M, Pattinson D, Ogura T, Baba R, Fujita K, Nagai H, Yamamoto S, Saito M, Adachi E, Ochi J, Hattori SI, Suzuki T, Miyazato Y, Chiba S, Okuda M, Murakami J, Hamabata T, Iwatsuki-Horimoto K, Nakajima H, Mitsuya H, Omagari N, Sugaya N, Yotsuyanagi H, Kawaoka Y. Antibody titers against SARS-CoV-2 decline, but do not disappear for several months. EClinicalMedicine 2021; 32:100734. [PMID: 33589882 PMCID: PMC7877219 DOI: 10.1016/j.eclinm.2021.100734] [Citation(s) in RCA: 115] [Impact Index Per Article: 38.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2020] [Revised: 01/10/2021] [Accepted: 01/13/2021] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND To develop an effective vaccine against a novel viral pathogen, it is important to understand the longitudinal antibody responses against its first infection. Here we performed a longitudinal study of antibody responses against SARS-CoV-2 in symptomatic patients. METHODS Sequential blood samples were collected from 39 individuals at various timepoints between 0 and 154 days after onset. IgG or IgM titers to the receptor binding domain (RBD) of the S protein, the ectodomain of the S protein, and the N protein were determined by using an ELISA. Neutralizing antibody titers were measured by using a plaque reduction assay. FINDINGS The IgG titers to the RBD of the S protein, the ectodomain of the S protein, and the N protein peaked at about 20 days after onset, gradually decreased thereafter, and were maintained for several months after onset. Extrapolation modeling analysis suggested that the IgG antibodies were maintained for this amount of time because the rate of reduction slowed after 30 days post-onset. IgM titers to the RBD decreased rapidly and disappeared in some individuals after 90 days post-onset. All patients, except one, possessed neutralizing antibodies against authentic SARS-CoV-2, which they retained at 90 days after onset. The highest antibody titers in patients with severe infections were higher than those in patients with mild or moderate infections, but the decrease in antibody titer in the severe infection cohort was more remarkable than that in the mild or moderate infection cohort. INTERPRETATION Although the number of patients is limited, our results show that the antibody response against the first SARS-CoV-2 infection in symptomatic patients is typical of that observed in an acute viral infection. FUNDING The Japan Agency for Medical Research and Development and the National Institutes of Allergy and Infectious Diseases.
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Affiliation(s)
- Seiya Yamayoshi
- Division of Virology, Department of Microbiology and Immunology, Institute of Medical Science, University of Tokyo, Japan
| | - Atsuhiro Yasuhara
- Division of Virology, Department of Microbiology and Immunology, Institute of Medical Science, University of Tokyo, Japan
| | - Mutsumi Ito
- Division of Virology, Department of Microbiology and Immunology, Institute of Medical Science, University of Tokyo, Japan
| | - Osamu Akasaka
- Emergency Medical Center, Fujisawa City Hospital, Japan
| | - Morio Nakamura
- Department of Pulmonary Medicine, Tokyo Saiseikai Central Hospital, Japan
| | - Ichiro Nakachi
- Pulmonary division, Department of Internal Medicine, Saiseikai Utsunomiya Hospital, Japan
| | - Michiko Koga
- Division of Infectious Diseases, Advanced Clinical Research Center, Institute of Medical Science, University of Tokyo, Japan
- Department of Infectious Diseases and Applied Immunology, IMSUT Hospital of Institute of Medical Science, the University of Tokyo, Japan
| | - Keiko Mitamura
- Division of Infection Control, Eiju General Hospital, Japan
| | - Kazuma Yagi
- Department of Pulmonary Medicine, Department of Medicine, Keiyu Hospital, Japan
| | - Kenji Maeda
- Department of Refractory Viral Infections, National Center for Global Health and Medicine Research Institute, Japan
| | - Hideaki Kato
- Infection Prevention and Control Department, Yokohama City University Hospital, Japan
- Department of Hematology and Clinical Immunology, Yokohama City University School of Medicine, Japan
| | - Masanori Nojima
- Center for Translational Research, Institute of Medical Science Hospital, University of Tokyo, Japan
| | - David Pattinson
- Department of Pathobiological Sciences, School of Veterinary Medicine, University of Wisconsin-Madison, USA
| | - Takayuki Ogura
- Department of Emergency Medicine and Critical Care Medicine, Saiseikai Utsunomiya Hospital, Japan
| | - Rie Baba
- Pulmonary division, Department of Internal Medicine, Saiseikai Utsunomiya Hospital, Japan
| | - Kensuke Fujita
- Department of Emergency Medicine and Critical Care Medicine, Saiseikai Utsunomiya Hospital, Japan
| | - Hiroyuki Nagai
- Department of Infectious Diseases and Applied Immunology, IMSUT Hospital of Institute of Medical Science, the University of Tokyo, Japan
| | - Shinya Yamamoto
- Division of Infectious Diseases, Advanced Clinical Research Center, Institute of Medical Science, University of Tokyo, Japan
- Department of Infectious Diseases and Applied Immunology, IMSUT Hospital of Institute of Medical Science, the University of Tokyo, Japan
| | - Makoto Saito
- Division of Infectious Diseases, Advanced Clinical Research Center, Institute of Medical Science, University of Tokyo, Japan
- Department of Infectious Diseases and Applied Immunology, IMSUT Hospital of Institute of Medical Science, the University of Tokyo, Japan
| | - Eisuke Adachi
- Department of Infectious Diseases and Applied Immunology, IMSUT Hospital of Institute of Medical Science, the University of Tokyo, Japan
| | - Junichi Ochi
- Department of Respiratory Medicine, Eiju General Hospital, Japan
| | - Shin-ichiro Hattori
- Department of Refractory Viral Infections, National Center for Global Health and Medicine Research Institute, Japan
| | - Tetsuya Suzuki
- Disease Control and Prevention Center, National Center for Global Health and Medicine Hospital, Japan
| | - Yusuke Miyazato
- Disease Control and Prevention Center, National Center for Global Health and Medicine Hospital, Japan
| | - Shiho Chiba
- Department of Pathobiological Sciences, School of Veterinary Medicine, University of Wisconsin-Madison, USA
| | - Moe Okuda
- Division of Virology, Department of Microbiology and Immunology, Institute of Medical Science, University of Tokyo, Japan
| | - Jurika Murakami
- Division of Virology, Department of Microbiology and Immunology, Institute of Medical Science, University of Tokyo, Japan
| | - Taiki Hamabata
- Division of Virology, Department of Microbiology and Immunology, Institute of Medical Science, University of Tokyo, Japan
| | - Kiyoko Iwatsuki-Horimoto
- Division of Virology, Department of Microbiology and Immunology, Institute of Medical Science, University of Tokyo, Japan
| | - Hideaki Nakajima
- Department of Hematology and Clinical Immunology, Yokohama City University School of Medicine, Japan
| | - Hiroaki Mitsuya
- Department of Refractory Viral Infections, National Center for Global Health and Medicine Research Institute, Japan
| | - Norio Omagari
- Disease Control and Prevention Center, National Center for Global Health and Medicine Hospital, Japan
| | | | - Hiroshi Yotsuyanagi
- Division of Infectious Diseases, Advanced Clinical Research Center, Institute of Medical Science, University of Tokyo, Japan
- Department of Infectious Diseases and Applied Immunology, IMSUT Hospital of Institute of Medical Science, the University of Tokyo, Japan
| | - Yoshihiro Kawaoka
- Division of Virology, Department of Microbiology and Immunology, Institute of Medical Science, University of Tokyo, Japan
- Department of Pathobiological Sciences, School of Veterinary Medicine, University of Wisconsin-Madison, USA
- Department of Special Pathogens, International Research Center for Infectious Diseases, Institute of Medical Science, University of Tokyo, Japan
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Egi M, Ogura H, Yatabe T, Atagi K, Inoue S, Iba T, Kakihana Y, Kawasaki T, Kushimoto S, Kuroda Y, Kotani J, Shime N, Taniguchi T, Tsuruta R, Doi K, Doi M, Nakada T, Nakane M, Fujishima S, Hosokawa N, Masuda Y, Matsushima A, Matsuda N, Yamakawa K, Hara Y, Sakuraya M, Ohshimo S, Aoki Y, Inada M, Umemura Y, Kawai Y, Kondo Y, Saito H, Taito S, Takeda C, Terayama T, Tohira H, Hashimoto H, Hayashida K, Hifumi T, Hirose T, Fukuda T, Fujii T, Miura S, Yasuda H, Abe T, Andoh K, Iida Y, Ishihara T, Ide K, Ito K, Ito Y, Inata Y, Utsunomiya A, Unoki T, Endo K, Ouchi A, Ozaki M, Ono S, Katsura M, Kawaguchi A, Kawamura Y, Kudo D, Kubo K, Kurahashi K, Sakuramoto H, Shimoyama A, Suzuki T, Sekine S, Sekino M, Takahashi N, Takahashi S, Takahashi H, Tagami T, Tajima G, Tatsumi H, Tani M, Tsuchiya A, Tsutsumi Y, Naito T, Nagae M, Nagasawa I, Nakamura K, Nishimura T, Nunomiya S, Norisue Y, Hashimoto S, Hasegawa D, Hatakeyama J, Hara N, Higashibeppu N, Furushima N, Furusono H, Matsuishi Y, Matsuyama T, Minematsu Y, Miyashita R, Miyatake Y, Moriyasu M, Yamada T, Yamada H, Yamamoto R, Yoshida T, Yoshida Y, Yoshimura J, Yotsumoto R, Yonekura H, Wada T, Watanabe E, Aoki M, Asai H, Abe T, Igarashi Y, Iguchi N, Ishikawa M, Ishimaru G, Isokawa S, Itakura R, Imahase H, Imura H, Irinoda T, Uehara K, Ushio N, Umegaki T, Egawa Y, Enomoto Y, Ota K, Ohchi Y, Ohno T, Ohbe H, Oka K, Okada N, Okada Y, Okano H, Okamoto J, Okuda H, Ogura T, Onodera Y, Oyama Y, Kainuma M, Kako E, Kashiura M, Kato H, Kanaya A, Kaneko T, Kanehata K, Kano K, Kawano H, Kikutani K, Kikuchi H, Kido T, Kimura S, Koami H, Kobashi D, Saiki I, Sakai M, Sakamoto A, Sato T, Shiga Y, Shimoto M, Shimoyama S, Shoko T, Sugawara Y, Sugita A, Suzuki S, Suzuki Y, Suhara T, Sonota K, Takauji S, Takashima K, Takahashi S, Takahashi Y, Takeshita J, Tanaka Y, Tampo A, Tsunoyama T, Tetsuhara K, Tokunaga K, Tomioka Y, Tomita K, Tominaga N, Toyosaki M, Toyoda Y, Naito H, Nagata I, Nagato T, Nakamura Y, Nakamori Y, Nahara I, Naraba H, Narita C, Nishioka N, Nishimura T, Nishiyama K, Nomura T, Haga T, Hagiwara Y, Hashimoto K, Hatachi T, Hamasaki T, Hayashi T, Hayashi M, Hayamizu A, Haraguchi G, Hirano Y, Fujii R, Fujita M, Fujimura N, Funakoshi H, Horiguchi M, Maki J, Masunaga N, Matsumura Y, Mayumi T, Minami K, Miyazaki Y, Miyamoto K, Murata T, Yanai M, Yano T, Yamada K, Yamada N, Yamamoto T, Yoshihiro S, Tanaka H, Nishida O. The Japanese Clinical Practice Guidelines for Management of Sepsis and Septic Shock 2020 (J-SSCG 2020). Acute Med Surg 2021; 8:e659. [PMID: 34484801 PMCID: PMC8390911 DOI: 10.1002/ams2.659] [Citation(s) in RCA: 33] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
The Japanese Clinical Practice Guidelines for Management of Sepsis and Septic Shock 2020 (J-SSCG 2020), a Japanese-specific set of clinical practice guidelines for sepsis and septic shock created as revised from J-SSCG 2016 jointly by the Japanese Society of Intensive Care Medicine and the Japanese Association for Acute Medicine, was first released in September 2020 and published in February 2021. An English-language version of these guidelines was created based on the contents of the original Japanese-language version. The purpose of this guideline is to assist medical staff in making appropriate decisions to improve the prognosis of patients undergoing treatment for sepsis and septic shock. We aimed to provide high-quality guidelines that are easy to use and understand for specialists, general clinicians, and multidisciplinary medical professionals. J-SSCG 2016 took up new subjects that were not present in SSCG 2016 (e.g., ICU-acquired weakness [ICU-AW], post-intensive care syndrome [PICS], and body temperature management). The J-SSCG 2020 covered a total of 22 areas with four additional new areas (patient- and family-centered care, sepsis treatment system, neuro-intensive treatment, and stress ulcers). A total of 118 important clinical issues (clinical questions, CQs) were extracted regardless of the presence or absence of evidence. These CQs also include those that have been given particular focus within Japan. This is a large-scale guideline covering multiple fields; thus, in addition to the 25 committee members, we had the participation and support of a total of 226 members who are professionals (physicians, nurses, physiotherapists, clinical engineers, and pharmacists) and medical workers with a history of sepsis or critical illness. The GRADE method was adopted for making recommendations, and the modified Delphi method was used to determine recommendations by voting from all committee members. As a result, 79 GRADE-based recommendations, 5 Good Practice Statements (GPS), 18 expert consensuses, 27 answers to background questions (BQs), and summaries of definitions and diagnosis of sepsis were created as responses to 118 CQs. We also incorporated visual information for each CQ according to the time course of treatment, and we will also distribute this as an app. The J-SSCG 2020 is expected to be widely used as a useful bedside guideline in the field of sepsis treatment both in Japan and overseas involving multiple disciplines.
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Nakama R, Kadoya T, Kimura T, Arakawa K, Ogura T, Kase K. Transcatheter Arterial Embolization of a Gluteal Pseudoaneurysm Due to Ground-Level Fall in an Elderly Woman Taking Apixaban. Interventional Radiology 2021; 6:1-3. [PMID: 35910527 PMCID: PMC9327326 DOI: 10.22575/interventionalradiology.2020-0012] [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] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Accepted: 10/11/2020] [Indexed: 12/05/2022]
Abstract
A 90-year-old woman prescribed with apixaban was admitted to a hospital after a ground-level fall. She was transferred to our hospital for advanced evaluation and treatment. Contrast-enhanced computed tomography showed a pseudoaneurysm inside the right gluteus maximus muscle. Angiography revealed an aneurysm of the peripheral branch of the inferior gluteal artery and multiple slight pseudoaneurysms of the peripheral branch of the internal iliac artery. We performed transcatheter arterial embolization using a gelatin sponge. After embolization, the hemoglobin stabilized. She was transferred to another hospital for rehabilitation. The use of direct oral anticoagulants in the elderly can lead to significant hemorrhage with minimal trauma. Transcatheter arterial embolization is a minimally invasive and safe procedure for such cases of trauma.
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Affiliation(s)
- Rakuhei Nakama
- Department of Emergency Medicine and Critical Care Medicine, Saiseikai Utsunomiya Hospital
- Department of Radiology, Saiseikai Utsunomiya Hospital
| | - Takashi Kadoya
- Department of Emergency Medicine and Critical Care Medicine, Saiseikai Utsunomiya Hospital
| | - Takuya Kimura
- Department of Emergency Medicine and Critical Care Medicine, Saiseikai Utsunomiya Hospital
| | | | - Takayuki Ogura
- Department of Emergency Medicine and Critical Care Medicine, Saiseikai Utsunomiya Hospital
| | - Kenichi Kase
- Department of Emergency Medicine and Critical Care Medicine, Saiseikai Utsunomiya Hospital
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Fujita K, Konn A, Ogura T, Kon Y, Kondo E, Konno S, Nodagashira T. Prehospital extracorporeal cardiopulmonary resuscitation for cardiac arrest patients in rural areas: a case report of two patients. Acute Med Surg 2020; 7:e577. [PMID: 33343907 PMCID: PMC7734470 DOI: 10.1002/ams2.577] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2020] [Revised: 08/02/2020] [Accepted: 09/03/2020] [Indexed: 11/12/2022] Open
Abstract
Background The prognosis of out-of-hospital cardiac arrest remains poor, especially for cardiopulmonary arrest patients in rural areas with longer transport duration to hospitals. Case Presentation In June 2016, we began providing prehospital extracorporeal life support using a mobile operating room for emergency surgery. We report two patients who survived after receiving prehospital extracorporeal cardiopulmonary resuscitation and were discharged. A patient with cardiopulmonary arrest from accidental hypothermia due to drowning survived with good neurological outcomes after on-site extracorporeal cardiopulmonary resuscitation immediately after rescue. The other patient who survived experienced cardiopulmonary arrest at his workplace, which was approximately 90 min from the center. Prehospital extracorporeal cardiopulmonary resuscitation shortened the cardiopulmonary arrest time by an estimated 30 min, and the patient survived until the hospital. Conclusion Prehospital extracorporeal cardiopulmonary resuscitation has the potential to save lives in rural areas by reducing low-flow time.
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Affiliation(s)
- Kensuke Fujita
- Department of Emergency and Critical Care Medicine Hachinohe City Hospital Hachinohe Japan.,Department of Emergency Medicine and Critical Care Medicine Tochigi Prefectural Emergency and Critical Care Center Imperial Foundation Saiseikai Utsunomiya Hospital Utsunomiya Japan
| | - Akihide Konn
- Department of Emergency and Critical Care Medicine Hachinohe City Hospital Hachinohe Japan
| | - Takayuki Ogura
- Department of Emergency Medicine and Critical Care Medicine Tochigi Prefectural Emergency and Critical Care Center Imperial Foundation Saiseikai Utsunomiya Hospital Utsunomiya Japan
| | - Yuri Kon
- Department of Emergency and Critical Care Medicine Division of Emergency and Trauma Radiology St. Marianna University School of Medicine Kawasaki Japan
| | - Eiji Kondo
- Department of Emergency and Critical Care Medicine Hachinohe City Hospital Hachinohe Japan
| | - Shingo Konno
- Department of Emergency and Critical Care Medicine Hachinohe City Hospital Hachinohe Japan
| | - Tatsuya Nodagashira
- Department of Emergency and Critical Care Medicine Hachinohe City Hospital Hachinohe Japan
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Yamayoshi S, Sakai-Tagawa Y, Koga M, Akasaka O, Nakachi I, Koh H, Maeda K, Adachi E, Saito M, Nagai H, Ikeuchi K, Ogura T, Baba R, Fujita K, Fukui T, Ito F, Hattori SI, Yamamoto K, Nakamoto T, Furusawa Y, Yasuhara A, Ujie M, Yamada S, Ito M, Mitsuya H, Omagari N, Yotsuyanagi H, Iwatsuki-Horimoto K, Imai M, Kawaoka Y. Comparison of Rapid Antigen Tests for COVID-19. Viruses 2020; 12:v12121420. [PMID: 33322035 PMCID: PMC7764512 DOI: 10.3390/v12121420] [Citation(s) in RCA: 135] [Impact Index Per Article: 33.8] [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] [Subscribe] [Scholar Register] [Received: 11/12/2020] [Revised: 11/28/2020] [Accepted: 12/08/2020] [Indexed: 02/04/2023] Open
Abstract
Reverse transcription-quantitative PCR (RT-qPCR)-based tests are widely used to diagnose coronavirus disease 2019 (COVID-19). As a result that these tests cannot be done in local clinics where RT-qPCR testing capability is lacking, rapid antigen tests (RATs) for COVID-19 based on lateral flow immunoassays are used for rapid diagnosis. However, their sensitivity compared with each other and with RT-qPCR and infectious virus isolation has not been examined. Here, we compared the sensitivity among four RATs by using severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) isolates and several types of COVID-19 patient specimens and compared their sensitivity with that of RT-qPCR and infectious virus isolation. Although the RATs read the samples containing large amounts of virus as positive, even the most sensitive RAT read the samples containing small amounts of virus as negative. Moreover, all RATs tested failed to detect viral antigens in several specimens from which the virus was isolated. The current RATs will likely miss some COVID-19 patients who are shedding infectious SARS-CoV-2.
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Affiliation(s)
- Seiya Yamayoshi
- Division of Virology, Department of Microbiology and Immunology, Institute of Medical Science, The University of Tokyo, Tokyo 108-8639, Japan; (Y.S.-T.); (Y.F.); (A.Y.); (M.U.); (S.Y.); (M.I.); (K.I.-H.); (M.I.)
- Correspondence: (S.Y.); (Y.K.)
| | - Yuko Sakai-Tagawa
- Division of Virology, Department of Microbiology and Immunology, Institute of Medical Science, The University of Tokyo, Tokyo 108-8639, Japan; (Y.S.-T.); (Y.F.); (A.Y.); (M.U.); (S.Y.); (M.I.); (K.I.-H.); (M.I.)
| | - Michiko Koga
- Division of Infectious Diseases, Advanced Clinical Research Center, Institute of Medical Science, The University of Tokyo, Tokyo 108-8639, Japan; (M.K.); (M.S.); (K.I.); (H.Y.)
- Department of Infectious Diseases and Applied Immunology, IMSUT Hospital of Institute of Medical Science, The University of Tokyo, Tokyo 108-8639, Japan; (E.A.); (H.N.)
| | - Osamu Akasaka
- Emergency Medical Center, Fujisawa City Hospital, Kanagawa 251-8550, Japan;
| | - Ichiro Nakachi
- Pulmonary Division, Department of Internal Medicine, Saiseikai Utsunomiya Hospital, Tochigi 321-0974, Japan; (I.N.); (R.B.)
| | - Hidefumi Koh
- Division of Pulmonary Medicine, Department of Internal Medicine, Tachikawa Hospital, Tokyo 190-8531, Japan; (H.K.); (T.F.); (F.I.)
| | - Kenji Maeda
- Department of Refractory Viral Infections, National Center for Global Health and Medicine Research Institute, Tokyo 162-8655, Japan; (K.M.); (S.-i.H.); (H.M.)
| | - Eisuke Adachi
- Department of Infectious Diseases and Applied Immunology, IMSUT Hospital of Institute of Medical Science, The University of Tokyo, Tokyo 108-8639, Japan; (E.A.); (H.N.)
| | - Makoto Saito
- Division of Infectious Diseases, Advanced Clinical Research Center, Institute of Medical Science, The University of Tokyo, Tokyo 108-8639, Japan; (M.K.); (M.S.); (K.I.); (H.Y.)
- Department of Infectious Diseases and Applied Immunology, IMSUT Hospital of Institute of Medical Science, The University of Tokyo, Tokyo 108-8639, Japan; (E.A.); (H.N.)
| | - Hiroyuki Nagai
- Department of Infectious Diseases and Applied Immunology, IMSUT Hospital of Institute of Medical Science, The University of Tokyo, Tokyo 108-8639, Japan; (E.A.); (H.N.)
| | - Kazuhiko Ikeuchi
- Division of Infectious Diseases, Advanced Clinical Research Center, Institute of Medical Science, The University of Tokyo, Tokyo 108-8639, Japan; (M.K.); (M.S.); (K.I.); (H.Y.)
- Department of Infectious Diseases and Applied Immunology, IMSUT Hospital of Institute of Medical Science, The University of Tokyo, Tokyo 108-8639, Japan; (E.A.); (H.N.)
| | - Takayuki Ogura
- Department of Emergency Medicine and Critical Care Medicine, Saiseikai Utsunomiya Hospital, Tochigi 321-0974, Japan; (T.O.); (K.F.)
| | - Rie Baba
- Pulmonary Division, Department of Internal Medicine, Saiseikai Utsunomiya Hospital, Tochigi 321-0974, Japan; (I.N.); (R.B.)
| | - Kensuke Fujita
- Department of Emergency Medicine and Critical Care Medicine, Saiseikai Utsunomiya Hospital, Tochigi 321-0974, Japan; (T.O.); (K.F.)
| | - Takahiro Fukui
- Division of Pulmonary Medicine, Department of Internal Medicine, Tachikawa Hospital, Tokyo 190-8531, Japan; (H.K.); (T.F.); (F.I.)
| | - Fumimaro Ito
- Division of Pulmonary Medicine, Department of Internal Medicine, Tachikawa Hospital, Tokyo 190-8531, Japan; (H.K.); (T.F.); (F.I.)
| | - Shin-ichiro Hattori
- Department of Refractory Viral Infections, National Center for Global Health and Medicine Research Institute, Tokyo 162-8655, Japan; (K.M.); (S.-i.H.); (H.M.)
| | - Kei Yamamoto
- Disease Control and Prevention Center, National Center for Global Health and Medicine Hospital, Tokyo 162-8655, Japan; (K.Y.); (T.N.); (N.O.)
| | - Takato Nakamoto
- Disease Control and Prevention Center, National Center for Global Health and Medicine Hospital, Tokyo 162-8655, Japan; (K.Y.); (T.N.); (N.O.)
| | - Yuri Furusawa
- Division of Virology, Department of Microbiology and Immunology, Institute of Medical Science, The University of Tokyo, Tokyo 108-8639, Japan; (Y.S.-T.); (Y.F.); (A.Y.); (M.U.); (S.Y.); (M.I.); (K.I.-H.); (M.I.)
| | - Atsuhiro Yasuhara
- Division of Virology, Department of Microbiology and Immunology, Institute of Medical Science, The University of Tokyo, Tokyo 108-8639, Japan; (Y.S.-T.); (Y.F.); (A.Y.); (M.U.); (S.Y.); (M.I.); (K.I.-H.); (M.I.)
| | - Michiko Ujie
- Division of Virology, Department of Microbiology and Immunology, Institute of Medical Science, The University of Tokyo, Tokyo 108-8639, Japan; (Y.S.-T.); (Y.F.); (A.Y.); (M.U.); (S.Y.); (M.I.); (K.I.-H.); (M.I.)
| | - Shinya Yamada
- Division of Virology, Department of Microbiology and Immunology, Institute of Medical Science, The University of Tokyo, Tokyo 108-8639, Japan; (Y.S.-T.); (Y.F.); (A.Y.); (M.U.); (S.Y.); (M.I.); (K.I.-H.); (M.I.)
| | - Mutsumi Ito
- Division of Virology, Department of Microbiology and Immunology, Institute of Medical Science, The University of Tokyo, Tokyo 108-8639, Japan; (Y.S.-T.); (Y.F.); (A.Y.); (M.U.); (S.Y.); (M.I.); (K.I.-H.); (M.I.)
| | - Hiroaki Mitsuya
- Department of Refractory Viral Infections, National Center for Global Health and Medicine Research Institute, Tokyo 162-8655, Japan; (K.M.); (S.-i.H.); (H.M.)
| | - Norio Omagari
- Disease Control and Prevention Center, National Center for Global Health and Medicine Hospital, Tokyo 162-8655, Japan; (K.Y.); (T.N.); (N.O.)
| | - Hiroshi Yotsuyanagi
- Division of Infectious Diseases, Advanced Clinical Research Center, Institute of Medical Science, The University of Tokyo, Tokyo 108-8639, Japan; (M.K.); (M.S.); (K.I.); (H.Y.)
- Department of Infectious Diseases and Applied Immunology, IMSUT Hospital of Institute of Medical Science, The University of Tokyo, Tokyo 108-8639, Japan; (E.A.); (H.N.)
| | - Kiyoko Iwatsuki-Horimoto
- Division of Virology, Department of Microbiology and Immunology, Institute of Medical Science, The University of Tokyo, Tokyo 108-8639, Japan; (Y.S.-T.); (Y.F.); (A.Y.); (M.U.); (S.Y.); (M.I.); (K.I.-H.); (M.I.)
| | - Masaki Imai
- Division of Virology, Department of Microbiology and Immunology, Institute of Medical Science, The University of Tokyo, Tokyo 108-8639, Japan; (Y.S.-T.); (Y.F.); (A.Y.); (M.U.); (S.Y.); (M.I.); (K.I.-H.); (M.I.)
| | - Yoshihiro Kawaoka
- Division of Virology, Department of Microbiology and Immunology, Institute of Medical Science, The University of Tokyo, Tokyo 108-8639, Japan; (Y.S.-T.); (Y.F.); (A.Y.); (M.U.); (S.Y.); (M.I.); (K.I.-H.); (M.I.)
- Department of Pathobiological Sciences, School of Veterinary Medicine, University of Wisconsin-Madison, Madison, WI 53706, USA
- International Research Center for Infectious Diseases, Department of Special Pathogens, Institute of Medical Science, The University of Tokyo, Tokyo 108-8639, Japan
- Correspondence: (S.Y.); (Y.K.)
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Ogura T, Nishioka N, Ueno S, Yamada M, Higuchi K. Gastrointestinal: Guidewire insertion under transluminal cholangioscopy guidance for a hepaticojejunostomy stricture resembling a pinhole. J Gastroenterol Hepatol 2020; 35:2029. [PMID: 32246861 DOI: 10.1111/jgh.15050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2019] [Accepted: 03/25/2020] [Indexed: 12/09/2022]
Affiliation(s)
- T Ogura
- 2nd Department of Internal Medicine, Osaka Medical College, Osaka, Japan
| | - N Nishioka
- 2nd Department of Internal Medicine, Osaka Medical College, Osaka, Japan
| | - S Ueno
- 2nd Department of Internal Medicine, Osaka Medical College, Osaka, Japan
| | - M Yamada
- 2nd Department of Internal Medicine, Osaka Medical College, Osaka, Japan
| | - K Higuchi
- 2nd Department of Internal Medicine, Osaka Medical College, Osaka, Japan
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Honda T, Yamasaki Y, Nakao H, Murakami Y, Ogura T, Kousaka Y, Akimitsu J. Topological metastability supported by thermal fluctuation upon formation of chiral soliton lattice in [Formula: see text]. Sci Rep 2020; 10:18596. [PMID: 33122696 PMCID: PMC7596096 DOI: 10.1038/s41598-020-74945-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Accepted: 10/07/2020] [Indexed: 11/29/2022] Open
Abstract
Topological magnetic structure possesses topological stability characteristics that make it robust against disturbances which are a big advantage for data processing or storage devices of spintronics; nonetheless, such characteristics have been rarely clarified. This paper focused on the formation of chiral soliton lattice (CSL), a one-dimensional topological magnetic structure, and provides a discussion of its topological stability and influence of thermal fluctuation. Herein, CSL responses against change of temperature and applied magnetic field were investigated via small-angle resonant soft X-ray scattering in chromium niobium sulfide ([Formula: see text]). CSL transformation relative to the applied magnetic field demonstrated a clear agreement with the theoretical prediction of the sine-Gordon model. Further, there were apparent differences in the process of chiral soliton creation and annihilation, discussed from the viewpoint of competing between thermal fluctuation and the topological metastability.
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Affiliation(s)
- T. Honda
- Institute of Materials Structure Science, High Energy Accelerator Research Organization (KEK), Tsukuba, 305-0801 Japan
| | - Y. Yamasaki
- Institute of Materials Structure Science, High Energy Accelerator Research Organization (KEK), Tsukuba, 305-0801 Japan
- Research and Services Division of Materials Data and Integrated System (MaDIS), National Institute for Materials Science (NIMS), Tsukuba, 305-0047 Japan
- Center for Emergent Matter Science (CEMS), RIKEN, Wako, 351-0198 Japan
- PRESTO, Japan Science and Technology Agency (JST), Saitama, Japan
| | - H. Nakao
- Institute of Materials Structure Science, High Energy Accelerator Research Organization (KEK), Tsukuba, 305-0801 Japan
| | - Y. Murakami
- Institute of Materials Structure Science, High Energy Accelerator Research Organization (KEK), Tsukuba, 305-0801 Japan
| | - T. Ogura
- Department of Physics and Mathematics, Aoyama-Gakuin University, Sagamihara, Kanagawa 252-5258 Japan
| | - Y. Kousaka
- Department of Physics and Electronics, Osaka Prefecture University, Osaka, 599-8531 Japan
| | - J. Akimitsu
- Research Institute for Interdisciplinary Science, Okayama University, Okayama, 700-8530 Japan
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Hayakawa M, Tagami T, IIjima H, Kudo D, Sekine K, Ogura T, Yumoto T, Kondo Y, Endo A, Ito K, Matsumura Y, Kushimoto S. Restrictive transfusion strategy for critically injured patients (RESTRIC) trial: a study protocol for a cluster-randomised, crossover non-inferiority trial. BMJ Open 2020; 10:e037238. [PMID: 32895281 PMCID: PMC7478023 DOI: 10.1136/bmjopen-2020-037238] [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] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
INTRODUCTION Resuscitation using blood products is critical during the acute postinjury period. However, the optimal target haemoglobin (Hb) levels have not been adequately investigated. With the restrictive transfusion strategy for critically injured patients (RESTRIC) trial, we aim to compare the restrictive and liberal red blood cell (RBC) transfusion strategies. METHODS AND ANALYSIS This is a cluster-randomised, crossover, non-inferiority trial of patients with severe trauma at 22 hospitals that have been randomised in a 1:1 ratio based on the use of a restrictive or liberal transfusion strategy with target Hb levels of 70-90 or 100-120 g/L, respectively, during the first year. Subsequently, after 1-month washout period, another transfusion strategy will be applied for an additional year. RBC transfusion requirements are usually unclear on arrival at the emergency department. Therefore, patients with severe bleeding, which could lead to haemorrhagic shock, will be included in the trial based on the attending physician's judgement. Each RBC transfusion strategy will be applied until 7 days postadmission to the hospital or discharge from the intensive care unit. The outcomes measured will include the 28-day survival rate after arrival at the emergency department (primary), the cumulative amount of blood transfused, event-free days and frequency of transfusion-associated lung injury and organ failure (secondary). Demonstration of the non-inferiority of restrictive transfusion will emphasise its clinical advantages. ETHICS AND DISSEMINATION The trial will be performed according to the Japanese and International Ethical guidelines. It has been approved by the Ethics Committee of each participating hospital and The Japanese Association for the Surgery of Trauma (JAST). Written informed consent will be obtained from all patients or their representatives. The results of the trial will be disseminated to the participating hospitals and board-certified educational institutions of JAST, submitted to peer-reviewed journals for publication, and presented at congresses. TRIAL REGISTRATION NUMBER UMIN Clinical Trials Registry; UMIN000034405. Registered 8 October 2018.
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Affiliation(s)
- Mineji Hayakawa
- Department of Emergency Medicine, Hokkaido University Hospital, Sapporo, Japan
| | - Takashi Tagami
- Department of Emergency and Critical Care Medicine, Nippon Medical School Musashikosugi Hospital, Kawasaki, Kanagawa, Japan
- Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, Bunkyo-ku, Tokyo, Japan
| | | | - Daisuke Kudo
- Division of Emergency and Critical Care Medicine, Tohoku University School of Medicine, Sendai, Miyagi, Japan
| | - Kazuhiko Sekine
- Department of Emergency and Critical Care Medicine, Saiseikai Central Hospital, Minato-ku, Tokyo, Japan
| | - Takayuki Ogura
- Department of Emergency Medicine & Critical Care Medicine, Advanced Medical Emergency and Critical Care Center, Japan Red Cross Maebashi Hospital, Maebashi, Gunma, Japan
| | - Tetsuya Yumoto
- Emergency, Critical Care, and Disaster Medicine, Okayama University Graduate School of Medicine Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Yutaka Kondo
- Department of Emergency and Critical Care Medicine, Juntendo University Urayasu Hospital, Urayasu, Chiba, Japan
| | - Akira Endo
- Trauma and Acute Critical Care Centre, Medical Hospital of Tokyo Medical and Dental University, Bunkyo-ku, Tokyo, Japan
| | - Kaori Ito
- Department of Emergency Medicine, Division of Acute Care Surgery, Teikyo University School of Medicine Graduate School of Medicine, Itabashi-ku, Tokyo, Japan
| | - Yosuke Matsumura
- Department of Emergency and Critical Care Medicine, Chiba University Graduate School of Medicine, Chiba, Chiba, Japan
| | - Shigeki Kushimoto
- Division of Emergency and Critical Care Medicine, Tohoku University School of Medicine, Sendai, Miyagi, Japan
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