論文 - 山元　良

Veno-arterial extracorporeal membrane oxygenation uses in trauma: a retrospective analysis of the Japanese nationwide trauma registry

Akutsu T., Endo A., Yamamoto R., Yamakawa K., Suzuki K., Hoshi H., Otomo Y., Morishita K.

BMC Emergency Medicine 24 （ 1 ） 179 2024年12月

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Background: Extracorporeal membrane oxygenation (ECMO) can provide temporary circulatory support and vital organ oxygenation and is potentially useful as a bridge therapy in some trauma cases. We aimed to demonstrate the characteristics and outcomes of patients with trauma treated with veno-arterial ECMO (V-A ECMO) using data from a Japanese nationwide trauma registry. Methods: This retrospective descriptive study analyzed data from the Japan Trauma Data Bank between January 2019 and December 2021. Patients with severe trauma (injury severity score [ISS] ≥ 9) and treated using V-A ECMO were assessed. Results: Among the 72,439 patients with severe trauma, 51 received V-A ECMO. Sixteen patients (31.3%) survived until hospital discharge. On hospital arrival, six (37.5%) survivors and 15 (42.9%) non-survivors experienced cardiac arrest. The median ISS for the survivor and non-survivor group was 25 (range, 25–39) and 25 (range, 17–33), respectively. Thoracic trauma was the most common type of trauma in both groups. In the non-survivor group, open-chest cardiopulmonary resuscitation, aortic cross-clamping, and resuscitative endovascular balloon occlusion of the aorta were performed in 10 (28.6%), 5 (14.3%), and 4 (11.4%) patients, respectively. However, these procedures were not performed in the survivor group. Peripheral oxygen saturation tended to be lower in the survivor group both before and upon arrival at the hospital. Conclusions: The results of this study suggest the potential benefit of V-A ECMO in some challenging trauma cases. Further studies are warranted to assess the indications for V-A ECMO in patients with trauma.

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Use of resuscitative endovascular balloon occlusion of the aorta (REBOA) for trauma and its performance in Japan over the past 18 years: a nationwide descriptive study

Hoshi H., Endo A., Yamamoto R., Yamakawa K., Suzuki K., Akutsu T., Morishita K.

World Journal of Emergency Surgery 19 （ 1 ） 19 2024年12月

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Background: Resuscitative endovascular balloon occlusion of the aorta (REBOA) has been used to control massive hemorrhages. Although there is no consensus on the efficacy of REBOA, it remains an option as a bridging therapy in non-trauma centers where trauma surgeons are not available. To better understand the current landscape of REBOA application, we examined changes in its usage, target population, and treatment outcomes in Japan, where immediate hemostasis procedures sometimes cannot be performed. Methods: This retrospective observational study used the Japan Trauma Data Bank data. All cases in which REBOA was performed between January 2004 and December 2021 were included. The primary outcome was the in-hospital mortality rate. We analyzed mortality trends over time according to the number of cases, number of centers, severity of injury, and overall and subgroup mortality associated with REBOA usage. We performed a logistic analysis of mortality trends over time, adjusting for probability of survival based on the trauma and injury severity score. Results: Overall, 2557 patients were treated with REBOA and were deemed eligible for inclusion. The median age of the participants was 55 years, and male patients constituted 65.3% of the study population. Blunt trauma accounted for approximately 93.0% of the cases. The number of cases and facilities that used REBOA increased until 2019. While the injury severity score and revised trauma score did not change throughout the observation period, the hospital mortality rate decreased from 91.3 to 50.9%. The REBOA group without severe head or spine injuries showed greater improvement in mortality than the all-patient group using REBOA and all-trauma patient group. The greatest improvement in mortality was observed in patients with systolic blood pressure ≥ 80 mmHg. The adjusted odds ratios for hospital mortality steadily declined, even after adjusting for the probability of survival. Conclusions: While there was no significant change in patient severity, mortality of patients treated with REBOA decreased over time. Further research is required to determine the reasons for these improvements in trauma care.

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Differences in outcomes of patients with out-of-hospital cardiac arrest treated with extracorporeal cardiopulmonary resuscitation between day-time and night-time

Koguchi H., Takayama W., Otomo Y., Morishita K., Inoue A., Hifumi T., Sakamoto T., Kuroda Y., Senda A., Suzuki H., Tanimoto A., Kitagawa K., Katayama Y., Igarashi N., Kawano M., Kuroki Y., Umehara T., Sasaki Y., Tominaga N., Hamaguchi T., Sakai T., Abe T., Hanafusa H., Yamaoka Y., Kakizaki Y., Sakato S., Kashiwabara S., Kadoya T., Misumi K., Kobayashi T., SouYamada , Kobayashi M., Akashi N., Kuno M., Maruyama J., Kobata H., Soh M., Shirasaki K., Shiba D., Isokawa S., Uchida M., Sakurai A., Tatsukawa H., Nishikawa M., Kojima M., Kosaki R., Shimazui T., Kinoshita H., Sawada Y., Yamamoto R., Masuzawa Y., Matsumura K., Shimazaki J.

Scientific Reports 14 （ 1 ）  2024年12月

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Although patients who underwent night-time resuscitation for out-of-hospital cardiac arrest (OHCA) had worse clinical outcomes than those who underwent day-time resuscitation, the differences between the outcomes of patients with OHCA who underwent extracorporeal cardiopulmonary resuscitation (ECPR) in the day-time and night-time remain unclear. We analyzed data from the Study of Advanced Life Support for Ventricular Fibrillation with Extracorporeal Circulation in Japan. Patients were categorized according to whether they received treatment during the day-time or night-time. The primary outcomes were survival to hospital discharge and favorable neurological outcome at discharge, and the secondary outcomes were estimated low-flow time, implementation time of ECPR, and complications due to ECPR. A multivariate logistic regression model adjusted for confounders was used for comparison. Among the 1644 patients, the night-time patients had a significantly longer ECMO implementation time and estimated low-flow time than the day-time patients, along with a significantly higher number of complications than the day-time patients. However, the survival and neurologically favorable survival rates did not differ significantly between the groups. Thus, although patients who underwent ECPR at night had an increased risk of longer implementation time and complications, their clinical outcomes did not differ from those who underwent day-time ECPR.

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Association between preoperative lactate level and early complications after surgery for isolated extremity fracture

Nishida Y., Yamamoto R., Ono S., Sasaki J.

BMC Musculoskeletal Disorders 25 （ 1 ） 314 2024年12月

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Background: The role of lactate level in selecting the timing of definitive surgery for isolated extremity fracture remains unclear. Therefore, we aimed to elucidate the use of preoperative lactate level for predicting early postoperative complications. Methods: This was a single-center retrospective observational study of patients with isolated extremity fracture who underwent orthopedic surgery. Patients who underwent lactate level assessment within 24 h prior to surgery were included. The incidence of early postoperative complications was compared between patients with a preoperative lactate level of ≥ 2 and < 2 mmol/L. Moreover, subgroup analyses were performed based on the time from hospital arrival to surgery and fracture type. Results: In total, 187 patients were included in the study. The incidence of postoperative complications was significantly higher in patients with a preoperative lactate level of ≥ 2 mmol/L than those with a preoperative lactate level of < 2 mmol/L. This result did not change after adjusting for age and severity. Further, a high preoperative lactate level was associated with a greater incidence of postoperative complications in patients who underwent definitive surgery within 6 h after arrival. Conclusion: A preoperative lactate level of ≥ 2 mmol/L was associated with a greater incidence of early postoperative complications in isolated extremity fractures. Nevertheless, this correlation was only observed among patients who underwent definitive fixation within 6 h after hospital arrival.

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Prehospital endotracheal intubation for traumatic out-of-hospital cardiac arrest and improved neurological outcomes.

Yamamoto R, Suzuki M, Takemura R, Sasaki J

Emergency medicine journal : EMJ 2024年11月

ISSN  1472-0205

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Effect of intravenous thiamine administration on critically ill patients: A systematic review and meta-analysis of randomized controlled trials

Nakanishi N., Abe Y., Matsuo M., Tampo A., Yamada K., Hatakeyama J., Yoshida M., Yamamoto R., Higashibeppu N., Nakamura K., Kotani J.

Clinical Nutrition 43 （ 11 ） 1 - 9 2024年11月

ISSN  02615614

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Background &Aims: Thiamine is an essential micronutrient for energy metabolism. Thiamine deficiency is frequently observed in critically ill patients. However, the effect of thiamine administration is unclear in critically ill patients. Methods: We conducted a systematic review and meta-analysis. To identify randomized controlled trials on the effect of thiamine administration in critically ill patients, a literature search was conducted in MEDLINE, CENTRAL, and ICHUSHI databases from inception to April 2023. Pooled effect estimates were calculated about mortality as the primary outcome and shock duration, lactate level, Sequential Organ Failure Assessment (SOFA) score, delirium, length of mechanical ventilation, length of intensive care unit (ICU) stay, infection rate, all adverse events, and Short-Form Health Survey (SF-36) as the secondary outcomes. The certainty of evidence (CoE) was assessed using the Grading of Recommendations Assessment, Development, and Evaluation approach. Results: Overall, 35 studies (3494 patients) were included. Evidence suggested that thiamine administration resulted in little to no difference in mortality (risk ratio [RR], 0.89; 95% confidence interval [CI], 0.75 to 1.06; Low CoE); however, thiamine administration may reduce shock duration (mean difference [MD], −11.43 h; 95% CI, −20.16 to −2.69 h; Low CoE), lactate level (MD, −0.34 mmol/L; 95% CI, −0.63 to −0.05 mmol/L; Low CoE), and SOFA score (MD, −1.29; 95% CI, −1.91 to −0.66; Low CoE). Conversely, thiamine administration resulted in a slight increase in the length of ICU stay (MD, 0.40 days; 95% CI, 0.01–0.79 days; High CoE). Conclusions: Although thiamine administration may reduce shock state, it may not reduce mortality, and slightly increases the length of ICU stay.

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Effects of high-fat, low-carbohydrate enteral nutrition in critically ill patients: A systematic review with meta-analysis

Ohbe H., Yoshida M., Okada K., Inoue T., Yamada K., Nakamura K., Yamamoto R., Nozaki A., Higashibeppu N., Kotani J.

Clinical Nutrition 43 （ 10 ） 2399 - 2406 2024年10月

ISSN  02615614

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Background & aims: High-fat, low-carbohydrate enteral nutrition has gained attention, with expectations of an improved respiratory condition, fewer complications, and lower mortality. The present study performed a systematic review and meta-analysis of randomized controlled trials to examine the effects of high-fat, low-carbohydrate enteral nutrition in critically ill adult patients. Methods: We searched MEDLINE via Pubmed, Cochrane Central Register of Controlled Trials (CENTRAL), and ICHUSHI for randomized controlled trials comparing high-fat, low-carbohydrate enteral nutrition to standard enteral nutrition in critically ill adult patients who received enteral nutrition. The primary outcome was mortality. Secondary outcomes included intensive care unit (ICU) mortality, length of ICU stay, length of mechanical ventilation, and adverse events of diarrhea and gastric residual volume. We examined the risk of bias using the Cochrane risk-of-bias tool for randomized trials version 2. We assessed the overall certainty of evidence based on the Grading of Recommendations Assessment, Development, and Evaluation methodology. Synthesis results were calculated with risk ratios and 95% confidence intervals using a Mantel-Haenszel random-effects model. Results: Eight trials with 607 patients were included. The effects of high-fat, low-carbohydrate enteral nutrition on mortality did not significantly differ from those of standard enteral nutrition (62/280 [22.1%] vs. 39/207 [18.8%], risk ratios = 1.14, 95% confidence intervals 0.80 to 1.62, P = 0.47). No significant differences were observed in ICU mortality, ICU length of stay, diarrhea, or gastric residual volume between the two groups. However, high-fat, low-carbohydrate enteral nutrition was associated with a significantly shorter duration of mechanical ventilation (mean difference −1.72 days, 95% confidence intervals −2.93 to −0.50, P = 0.005). Conclusion: High-fat, low-carbohydrate enteral nutrition may not affect mortality, but may decrease the duration of mechanical ventilation in critically ill adult patients. Limitations include the small number of studies and potential for bias. Further research is needed to confirm these results and investigate effects on other outcomes and in a subgroup of patients requiring mechanical ventilation.

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特集 内科医が知っておくべきICU・ERでの薬の使い方 血液 止血製剤

山元 良

medicina （株式会社医学書院）  61 （ 10 ） 1692 - 1695 2024年09月

ISSN  00257699

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Simple severity scale for perforated peptic ulcer with generalized peritonitis: A derivation and internal validation study.

Yamamoto R, Hirakawa S, Tachimori H, Matsuoka T, Kikuchi H, Hasegawa H, Shirabe K, Kakeji Y, Kawakubo H, Kitagawa Y, Sasaki J

International journal of surgery (London, England) 110 （ 11 ） 7134 - 41 2024年08月

ISSN  1743-9191

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Quality indicators for integrating oncology and home palliative care in Japan: modified Delphi study.

Hasegawa T, Ochi T, Yamagishi A, Akechi T, Urakubo A, Sugishita A, Yamamoto R, Kubota Y, Shimoyama S

Supportive care in cancer : official journal of the Multinational Association of Supportive Care in Cancer 32 （ 7 ） 476 2024年07月

ISSN  0941-4355

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Door-to-Needle Time for Extracorporeal Cardiopulmonary Resuscitation and Neurological Outcomes in Out-of-Hospital Cardiac Arrest: A Nationwide Study

Yamamoto R., Kaito D., Homma K., Inoue A., Hifumi T., Sakamoto T., Kuroda Y., Sasaki J.

Journal of the American Heart Association 13 （ 12 ） e034971 2024年06月

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BACKGROUND: Extracorporeal cardiopulmonary resuscitation (ECPR) is an option for refractory cardiac arrest, and immediate initiation after indication is recommended. However, the practical goals of ECPR preparation (such as the door-to-needle time) remain unclear. This study aimed to elucidate the association between the door-to-needle time and neurological outcomes of out-of-hospital cardiac arrest. METHODS AND RESULTS: This is a post hoc analysis of a nationwide multicenter study on out-of-hospital cardiac arrest treated with ECPR at 36 institutions between 2013 and 2018 (SAVE-J [Study of Advanced Cardiac Life Support for Ventricular Fibrillation with Extracorporeal Circulation in Japan] II study). Adult patients without hypothermia (≥32 °C) in whom circulation was not returned at ECPR initiation were included. The probability of favorable neurological function at 30 days (defined as Cerebral Performance Category ≤2) was estimated using a generalized estimating equations model, in which institutional, patient, and treatment char-acteristics were adjusted. Estimated probabilities were then calculated according to the door-to-needle time with 3-minute incre-ments, and a clinical threshold was assumed. Among 1298 patients eligible for this study, 136 (10.6%) had favorable neurological function. The estimated probability of favorable outcomes was highest in patients with 1 to 3 minutes of door-to-needle time (12.9% [11.4%–14.3%]) and remained at 9% to 10% until 27 to 30 minutes. Then, the probability dropped gradually with each 3-minute delay. A 30-minute threshold was assumed, and shorter door-to-extracorporeal membrane oxygenation/low-flow time and fewer adverse events related to cannulation were observed in patients with door-to-needle time <30 minutes. CONCLUSIONS: The probability of favorable functions after out-of-hospital cardiac arrest decreased as the door-to-needle time for ECPR was prolonged, with a rapid decline after 27 to 30 minutes. REGISTRATION: URL: https://center6.umin.ac.jp/cgi-open-bin/ctr/ctr_view.cgi?recptno=R000041577; Unique identifier: UMIN000036490.

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Simple parameters to identify patients treatable with early definitive fixation: A nationwide study

Udagawa K., Yamamoto R., Shimatani N., Nishida Y., Ono S., Niki Y., Sasaki J.

Injury 55 （ 6 ） 111117 2024年06月

ISSN  00201383

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Introduction: Early appropriate care (EAC) is widely accepted as a safe strategy to perform early definitive fracture fixation, and good clinical outcomes have been reported in selected, multiply injured patients, although the optimal candidate for early definitive fixation (EDF) has not been validated. The aim of this study was to identify simple clinical parameters to help select patients who could undergo EDF. Methods: Patients with extremity injuries who underwent open reduction and internal fixation were retrospectively identified, using data from the Japan Trauma Data Bank (JTDB). Age, vital signs on hospital presentation, and the injury severity score (ISS) were examined by transforming these variables to binary categories. Patients were divided into categories based on these variables, and in-hospital mortality was compared between patients treated with EDF (EDF group) and those treated without EDF (non-EDF group) in each category. Results: Of the 12,735 patients who were eligible for the analyses, 3706 (29.1 %) were managed with EDF. In-hospital mortality was significantly higher in the EDF group than in the non-EDF group among patients with a low Glasgow Coma Scale (GCS) score (<13), low systolic blood pressure (sBP) (<90 mmHg), and ISS≥15, whereas in-hospital mortality was comparable between the EDF and non-EDF groups among patients with GCS scores ≥13, sBP ≥90 mmHg, and ISS <15. Discussion: In this large nationwide database of trauma patients, EDF was performed without affecting mortality in patients with GCS scores ≥13 and sBP ≥90 mmHg on hospital presentation, as well as ISS <15. These parameters might be useful as screening tools to select the candidates who could be treated with EDF safely.

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Effects of Energy Delivery Guided by Indirect Calorimetry in Critically Ill Patients: A Systematic Review and Meta-Analysis

Watanabe S., Izumino H., Takatani Y., Tsutsumi R., Suzuki T., Tatsumi H., Yamamoto R., Sato T., Miyagi T., Miyajima I., Nakamura K., Higashibeppu N., Kotani J.

Nutrients 16 （ 10 ）  2024年05月

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BACKGROUND: The utility of using indirect calorimetry (IC) to estimate energy needs and methods for its application to this purpose remain unclear. This systematic review investigated whether using IC to estimate energy expenditure in critically ill patients is more meaningful for improving survival than other estimation methods. METHODS: Comprehensive searches were conducted in MEDLINE using PubMed, Cochrane Central Register of Controlled Trials, and Igaku-Chuo-Zasshi up to March 2023. RESULTS: Nine RCTs involving 1178 patients were included in the meta-analysis. The evidence obtained suggested that energy delivery by IC improved short-term mortality (risk ratio, 0.86; 95% confidence interval [CI], 0.70 to 1.06). However, the use of IC did not appear to affect the length of ICU stay (mean difference [MD], 0.86; 95% CI, -0.98 to 2.70) or the duration of mechanical ventilation (MD, 0.66; 95% CI, -0.39 to 1.72). Post hoc analyses using short-term mortality as the outcome found no significant difference by target calories in resting energy expenditure, whereas more frequent IC estimates were associated with lower short-term mortality and were more effective in mechanically ventilated patients. CONCLUSIONS: This updated meta-analysis revealed that the use of IC may improve short-term mortality in patients with critical illness and did not increase adverse events.

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Steroid therapy for patients with septic shock: A multicenter observational study conducted in Japan.

Murata M, Shimizu S, Yamamoto R, Kamitani T, Yamazaki H, Ogawa Y, Fukuhara S, Yasuda H, Yamamoto Y, AMOR-VENUS study group

Internal medicine (Tokyo, Japan) 2024年05月

ISSN  0918-2918

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Impact of antithymocyte globulin usage and risk stratification for posttransplant lymphoproliferative disorders in aplastic anemia patients after allogeneic hematopoietic cell transplantation.

Yamamoto R, Hiramoto N, Fujimoto A, Yamazaki H, Mori T, Uchida N, Doki N, Kato J, Nishikubo M, Kako S, Nishida T, Ota S, Onizuka M, Eto T, Onodera K, Ikegame K, Matsuoka KI, Kanda Y, Fukuda T, Atsuta Y, Onishi Y

Bone marrow transplantation 59 （ 5 ） 688 - 691 2024年05月

ISSN  0268-3369

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Special feature 医療従事者を守る職業感染制御の再点検 ■領域別スタッフの曝露対策のポイント　❶救急外来・手術室

山下 幾太郎, 山元 良, 佐々木 淳一

感染対策ICTジャーナル （(株)ヴァンメディカル）  19 （ 2 ） 125 - 130 2024年04月

ISSN  18814964

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Components and Delivery Formats of Cognitive Behavioral Therapy for Chronic Insomnia in Adults: A Systematic Review and Component Network Meta-Analysis.

Furukawa Y, Sakata M, Yamamoto R, Nakajima S, Kikuchi S, Inoue M, Ito M, Noma H, Takashina HN, Funada S, Ostinelli EG, Furukawa TA, Efthimiou O, Perlis M

JAMA psychiatry 81 （ 4 ） 357 - 365 2024年04月

ISSN  2168-622X

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Delta Shock Index and higher incidence of emergency surgery in older adults with blunt trauma

Funabiki S., Yamamoto R., Homma K., Yoshizawa J., Jia S., Takanashi Y., Kahara R., Sasaki J.

European Journal of Trauma and Emergency Surgery 50 （ 2 ） 561 - 566 2024年04月

ISSN  18639933

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Purpose: Vital signs are important for predicting clinical outcomes in patients with trauma. However, their accuracy can be affected in older adults because hemodynamic changes are less obvious. This study aimed to examine the usefulness of changes in vital signs during transportation in predicting the need for hemostatic treatments in older patients with trauma. Methods: This retrospective cohort study was conducted using data from the Japan Trauma Data Bank (2004–2019). Patients aged ≥ 65 years who were hemodynamically stable at the scene were included in this study. The incidence of emergency surgery within 12 h after hospital arrival was compared between patients with delta Shock Index (dSI) > 0.1 and those with dSI ≤ 0.1. Predicting ability was examined after adjusting for patient demographics, comorbidities, vital signs at the scene and on hospital arrival, Injury Severity Score, and abbreviated injury scale in each region. Results: Among the 139,242 patients eligible for the study, 3,701 underwent urgent hemostatic surgery within 12 h. Patients with dSI > 0.1 showed a significantly higher incidence of emergency surgery than those with dSI ≤ 0.1 (871/16,549 [5.3%] vs. 2,830/84,250 [3.4%]; odds ratio (OR), 1.60 [1.48–1.73]; adjusted OR, 1.22 [1.08–1.38]; p = 0.001). The relationship between high dSI and a higher incidence of intervention was observed in patients with hypertension and those with decreased consciousness on arrival. Conclusion: High dSI > 0.1 was significantly associated with a higher incidence of urgent hemostatic surgery in older patients.

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Immediate Angiography and Decreased In-Hospital Mortality of Adult Trauma Patients: A Nationwide Study

Yamamoto R., Maeshima K., Funabiki T., Eastridge B.J., Cestero R.F., Sasaki J.

CardioVascular and Interventional Radiology 47 （ 4 ） 472 - 480 2024年04月

ISSN  01741551

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Purpose: This study aimed to elucidate whether immediate angiography within 30 min is associated with lower in-hospital mortality compared with non-immediate angiography. Materials and Methods: We conducted a retrospective cohort study using a nationwide trauma databank (2019–2020). Adult trauma patients who underwent emergency angiography within 12 h after hospital arrival were included. Patients who underwent surgery before angiography were excluded. Immediate angiography was defined as one performed within 30 min after arrival (door-to-angio time ≤ 30 min). In-hospital mortality and non-operative management (NOM) failure were compared between patients with immediate and non-immediate angiography. Inverse probability weighting with propensity scores was conducted to adjust patient demographics, injury mechanism and severity, vital signs on hospital arrival, and resuscitative procedures. A restricted cubic spline curve was drawn to reveal survival benefits by door-to-angio time. Results: Among 1,455 patients eligible for this study, 92 underwent immediate angiography. Angiography ≤ 30 min was associated with decreased in-hospital mortality (5.0% vs 11.1%; adjusted odds ratio [OR], 0.42 [95% CI, 0.31–0.56]; p < 0.001), as well as lower frequency of NOM failure: thoracotomy and laparotomy after angiography (0.8% vs. 1.8%; OR, 0.44 [0.22–0.89] and 2.6% vs. 6.5%; OR, 0.38 [0.26–0.56], respectively). The spline curve showed a linear association between increasing mortality and prolonged door-to-angio time in the initial 100 min after arrival. Conclusion: In trauma patients, immediate angiography ≤ 30 min was associated with lower in-hospital mortality and fewer NOM failures. Level of Evidence: Level 3b, non randomized controlled cohort/follow up study. Graphical Abstract: (Figure presented.).

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尿酸クリアランスと院外心停止後の予後の関連 SOS-KANTO 2017 Study

多村 知剛, 山元 良, 本間 康一郎, 北村 伸哉, 野村 智久, 田上 隆, 康永 秀生, 麻生 将太郎, 武田 宗和, 佐々木 淳一

日本救急医学会関東地方会雑誌 （日本救急医学会-関東地方会）  45 （ 1 ） 80 - 80 2024年02月

ISSN  0287-301X

尿酸クリアランスと院外心停止後の予後の関連 SOS-KANTO 2017 Study

多村 知剛, 山元 良, 本間 康一郎, 北村 伸哉, 野村 智久, 田上 隆, 康永 秀生, 麻生 将太郎, 武田 宗和, 佐々木 淳一

日本救急医学会関東地方会雑誌 （日本救急医学会-関東地方会）  45 （ 1 ） 80 - 80 2024年02月

ISSN  0287-301X

Urine Output and Development of Acute Kidney Injury in Sepsis: A Multicenter Observational Study

Yamamoto R., Yamakawa K., Yoshizawa J., Kaito D., Umemura Y., Homma K., Sasaki J.

Journal of Intensive Care Medicine    8850666241268390 2024年

ISSN  08850666

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Background: Acute kidney injury (AKI) is common in sepsis and a urine output <0.5 mL/kg/h associated with increased mortality is incorporated into AKI diagnosis. We aimed to identify the urine-output threshold associated with increased AKI incidence and hypothesized that a higher urine output than a specified threshold, which differs from the predominantly used 0.5 mL/kg/h threshold, would be associated with an increased AKI incidence. Methods: This was a post-hoc analysis of a nationwide prospective observational study. This study included adult patients newly diagnosed with sepsis and requiring intensive care. Urine output on the day of sepsis diagnosis was categorized as low, moderate, or high (<0.5, 0.5-1.0, and >1.0 mL/kg/h, respectively), and we compared AKI incidence, renal replacement therapy (RRT) requirement, and 28-day survival by category. Estimated probabilities for these outcomes were also compared after adjusting for patient background and hourly fluid administration. Results: Among 172 eligible patients, AKI occurred in 46.3%, 48.3%, and 53.1% of those with high, moderate, and low urine output, respectively. The probability of AKI was lower in patients with high urine output than in those with low output (43.6% vs 56.5%; P =.028), whereas RRT requirement was lower in patients with high and moderate urine output (11.7% and 12.8% vs 49.1%; P <.001). Patients with low urine output demonstrated significantly lower survival (87.7% vs 82.8% and 67.8%; P =.018). Cubic spline curves for AKI, RRT, and survival prediction indicated different urine-output thresholds, including <1.2 to 1.3 mL/kg/h for AKI and <0.6 to 0.8 mL/kg/h for RRT and mortality risk. Conclusions: Urine output >1.0 mL/kg/h on the day of sepsis diagnosis was associated with lower AKI incidence. The urine-output threshold was higher for developing AKI than for RRT requirement or mortality.

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Follow-up computed tomography and unexpected hemostasis in non-operative management of pediatric blunt liver and spleen injury

Yamamoto R., Sato Y., Cestero R.F., Eastridge B.J., Maeshima K., Katsura M., Kondo Y., Yasuda H., Kushimoto S., Sasaki J.

European Journal of Trauma and Emergency Surgery 2024年

ISSN  18639933

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Purpose: While follow-up CT and prophylactic embolization with angiography are often conducted during non-operative management (NOM) for BLSI, particularly in a high-grade injury, the utility of early repeated CT for preventing unexpected hemorrhage remains unclear. This study aimed to elucidate whether early follow-up computerized tomography (CT) within 7 days after admission would decrease unexpected hemostatic procedures on pediatric blunt liver and spleen injury (BLSI). Methods: A post-hoc analysis of a multicenter observational cohort study on pediatric patients with BLSI (2008–2019) was conducted on those who underwent NOM, in whom the timing of follow-up CT were decided by treating physicians. The incidence of unexpected hemostatic procedure (laparotomy and/or emergency angiography for ruptured pseudoaneurysm) and complications related to BLSI were compared between patients with and without early follow-up CT within 7 days. Inverse probability weighting with propensity scores adjusted patient demographics, comorbidities, mechanism and severity of injury, initial resuscitation, and institutional characteristics. Results: Among 1320 included patients, 552 underwent early follow-up CT. Approximately 25% of patients underwent angiography on the day of admission. The incidence of unexpected hemostasis was similar between patients with and without early repeat CT (8 [1.4%] vs. 6 [0.8%]; adjusted OR, 1.44 [0.62–3.34]; p = 0.40). Patients with repeat CT scans more frequently underwent multiple angiographies (OR, 2.79 [1.32–5.88]) and had more complications related to BLSI, particularly bile leak (OR, 1.73 [1.04–2.87]). Conclusion: Follow-up CT scans within 7 days was not associated with reduced unexpected hemostasis in NOM for pediatric BLSI.

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日本版敗血症診療ガイドライン2024

志馬 伸朗, 中田 孝明, 矢田部 智昭, 山川 一馬, 青木 善孝, 井上 茂亮, 射場 敏明, 小倉 裕司, 河合 佑亮, 川口 敦, 川崎 達也, 近藤 豊, 櫻谷 正明, 對東 俊介, 土井 研人, 橋本 英樹, 原 嘉孝, 福田 龍将, 松嶋 麻子, 江木 盛時, 久志本 成樹, 大網 毅彦, 菊谷 知也, 相川 玄, 青木 誠, 赤塚 正幸, 淺井 英樹, 阿部 智一, 雨宮 優, 石澤 嶺, 石原 唯史, 石丸 忠賢, 糸洲 佑介, 井上 拓保, 今長谷 尚史, 井村 春樹, 岩崎 直也, 生塩 典敬, 内田 雅俊, 内 倫子, 梅垣 岳志, 梅村 穣, 遠藤 彰, 大井 真里奈, 大内 玲, 大沢 樹輝, 大島 良康, 太田 浩平, 大野 孝則, 岡田 遥平, 岡野 弘, 小川 新史, 柏浦 正広, 春日井 大介, 狩野 謙一, 上谷 遼, 河内 章, 川上 定俊, 川上 大裕, 川村 雄介, 神鳥 研二, 岸原 悠貴, 木村 翔, 久保 健児, 栗原 知己, 小網 博之, 小谷 祐樹, 木庭 茂, 佐藤 威仁, 佐藤 蓮, 澤田 悠輔, 志田 瑶, 島田 忠長, 志水 元洋, 清水 一茂, 白石 拓人, 新貝 達, 丹保 亜希仁, 杉浦 岳, 杉本 健輔, 杉本 裕史, 壽原 朋宏, 関野 元裕, 其田 健司, 對東 真帆子, 高橋 希, 竹下 淳, 武田 親宗, 立野 淳子, 田中 愛子, 谷 昌憲, 谷河 篤, 陳 昊, 土田 拓見, 堤 悠介, 恒光 健史, 出口 亮, 鉄原 健一, 寺山 毅郎, 戸上 由貴, 十時 崇彰, 友田 吉則, 中尾 俊一郎, 長澤 宏樹, 中谷 安寿, 中西 信人, 西岡 典宏, 錦見 満暁, 野口 智子, 野浪 豪, 野村 理, 橋本 克彦, 畠山 淳司, 濵井 康貴, 彦根 麻由, 久宗 遼, 廣瀬 智也, 福家 良太, 藤井 遼, 藤江 直輝, 藤永 潤, 藤浪 好寿, 藤原 翔, 舩越 拓, 本間 康一郎, 牧野 佑斗, 松浦 裕司, 松岡 綾華, 松岡 義, 松村 洋輔, 水野 彰人, 宮本 颯真, 三好 ゆかり, 村田 慧, 村田 哲平, 薬師寺 泰匡, 安尾 俊祐, 山田 浩平, 山田 博之, 山元 良, 山本 良平, 湯本 哲也, 吉田 裕治, 吉廣 尚大, 吉村 聡志, 吉村 旬平, 米倉 寛, 若林 侑起, 和田 剛志, 渡辺 伸一, 井尻 篤宏, 宇賀田 圭, 宇田 周司, 小野寺 隆太, 高橋 正樹, 中島 聡志, 本多 純太, 松本 承大, 日本版敗血症診療ガイドライン2024特別委員会

日本集中治療医学会雑誌 （一般社団法人 日本集中治療医学会）  advpub （ 0 ）  2024年

ISSN  13407988

　概要を見る

<p>日本集中治療医学会と日本救急医学会は合同で特別委員会を結成し、日本版敗血症診療ガイドライン2024年版（J-SSCG2024）として公表する。今回の改訂により、2012年の初版から数えて3回目の改訂となる。本ガイドラインの目的は、敗血症および敗血症性ショックの診療において、医療従事者が適切な判断を下し、患者の転帰改善につなげるための支援を行うことである。敗血症を認識し初期対応する医師、引き継いで専門家として診療する医師、そして看護師、理学療法士、臨床工学技士、薬剤師など、多職種の医療従事者にとって理解しやすく、使いやすいものを目指した。 J-SSCG2024は、敗血症の診断と感染源のコントロール、抗菌薬治療、初期蘇生・循環作動薬、急性血液浄化、DIC 診断と治療、その他の補助療法、PICS 対策、家族ケア、小児の9領域をカバーし、合計78 個の重要臨床課題を設定した。ガイドラインパネルには両学会から委員21名を任用し、ワーキンググループメンバー107名（医師、看護師、理学療法士、臨床工学技士、薬剤師）のサポートのもとに作成した。将来への発展性を見据えて、多くの若手医療従事者や研究者を含めた。また前回と同様に、中立的立場で領域を横断的に俯瞰するアカデミックガイドライン推進班を構成し、質の担保と作業過程の透明化を目的にパブリックコメントを募集した。作成手法にはGRADE（The Grading of Recommendations Assessment, Development and Evaluation）システムを採用し、質の高いガイドラインを目指した。7個のGood practice statement（GPS）と42個のGRADE に基づく推奨を提示した。その他に、Background question（BQ）22個、future research question（FRQ）12個の解説文を付記した。さらにガイドラインの幅広い普及と教育効果の向上を目指し、スマートフォンアプリを開発した。 本ガイドラインは日本集中治療医学会と日本救急医学会の両機関誌のガイドライン増刊号として同時掲載される。日本集中治療医学会と日本救急医学会の精鋭の英知が詰まった本ガイドラインが、より多くの関係者に利用され、評価され、1人でも多くの敗血症患者の転帰改善に繫がることを願っている。</p>

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人工真皮サンドウィッチ法の有用性：多施設共同前向き観察研究の立案および現状

山元 良, 佐藤 幸男, 松村 一, 池田 弘人, 今井 啓道, 上田 敬博, 福田 憲翁, 佐々木 淳一

熱傷 （一般社団法人 日本熱傷学会）  49 （ 5 ） 263 - 267 2023年12月

ISSN  0285113X

　概要を見る

<p> 本報告では, 皮膚移植に関する臨床研究の立案過程を解説する. さまざまな皮膚移植法が存在するなか, 人工真皮を用いた移植によって創の機能や整容を向上させる可能性が示唆されている. 従来, 人工真皮を用いた治療戦略では, 人工真皮の移植・生着確認ののちに自家分層植皮を行うという二期的手術が一般的であったが, 近年では自家網状分層植皮の表層に人工真皮の植皮を一期的に行うという手法, 人工真皮サンドウィッチ法が提案され, 臨床実用されている. しかし, その効果は証明されておらず, われわれはその有用性を評価するため多施設共同前向き観察研究を実施するにいたった. そこで, 本研究の立案・開始までの過程を紹介する. 研究立案期において, 人工真皮サンドウィッチ法の対象創と対照術式の設定に苦慮した. 最終的に, 期待される効果を総治療期間の短縮効果および採皮面積の縮小効果の2つに整理し検討した. 総治療期間の短縮効果を評価するために, 深部まで及ぶ皮膚欠損創を対象創とし, 人工真皮を用いる従来の二期的手術を対照術式とした. また, 採皮面積の減少効果を評価するために, 広範囲皮膚欠損創を対象とし, 低倍率網状分層植皮を対照術式とした. また, 術式選択に関して多くの交絡因子が存在することが考えられ, 皮膚移植対象創に関する過不足ない情報が何かを検討し, アウトカムの評価方法について深く議論したことが, 研究計画設定において非常に重要であったと考えられる. 本研究結果がつぎのランダム化比較試験へ繋がることを期待している. </p>

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Hyperoxia for sepsis and development of acute lung injury with increased mortality

Yamamoto R., Fujishima S., Yamakawa K., Abe T., Ogura H., Saitoh D., Gando S., Sasaki J.

BMJ Open Respiratory Research 10 （ 1 ）  2023年12月

　概要を見る

Background Supraphysiological oxygen administration causes unfavourable clinical outcomes in various diseases. This study aimed to determine whether hyperoxia would be associated with increased mortality in patients with severe infection. Methods A post-hoc analysis of a nationwide multicentre prospective observational study on sepsis (SPICE Study) was conducted, including adult patients admitted to the intensive care unit with available arterial partial pressure of oxygen (PaO2) at the treatment initiation for severe infection. Hyperoxia was defined as a PaO2 level of ≥300 mm Hg and in-hospital mortality was compared between patients with and without hyperoxia. Results Of the 563 patients eligible for the study, 49 had hyperoxia at treatment initiation for severe infection. The in-hospital all-cause mortality rates of patients with and without hyperoxia were 14 (29.2%) and 90 (17.6%), respectively. Inverse probability weighting analyses with propensity scores revealed the association between hyperoxia and increased in-hospital mortality rate (28.8% vs 18.8%; adjusted OR 1.75 (1.03 to 2.97); p=0.038), adjusting for patient demographics, comorbidities, site of infection, severity of infection, haemodynamic and respiratory status, laboratory data and location of patient at infection development. Acute lung injury developed more frequently in patients with hyperoxia on the following days after infection treatment, whereas sepsis-related mortality was comparable regardless of hyperoxia exposure. Conclusion Hyperoxia with PaO2 ≥300 mm Hg at treatment initiation of severe infection was associated with an increased in-hospital mortality rate in patients requiring intensive care. The amount of oxygen to administer to patients with severe infection should be carefully determined.

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Optimal tentative abdominal closure for open abdomen: a multicenter retrospective observational study (OPTITAC study)

Yamamoto R., Kuramoto S., Shimizu M., Shinozaki H., Miyake T., Sadakari Y., Sekine K., Kaneko Y., Kurosaki R., Koizumi K., Shibusawa T., Sakurai Y., Wakahara S., Sasaki J.

International journal of surgery (London, England) 109 （ 12 ） 4049 - 4056 2023年12月

ISSN  1743-9191

　概要を見る

BACKGROUND: Primary fascia closure is often difficult following an open abdomen (OA). While negative-pressure wound therapy (NPWT) is recommended to enhance successful primary fascia closure, the optimal methods and degree of negative pressure remain unclear. This study aimed to elucidate optimal methods of NPWT as a tentative abdominal closure for OA to achieve primary abdominal fascia closure. MATERIALS AND METHODS: A multicenter, retrospective, cohort study of adults who survived OA greater than 48 h was conducted in 12 institutions between 2010 and 2022. The achievement of primary fascia closure and incidence of enteroatmospheric fistula were examined based on methods (homemade, superficial NPWT kit, or open-abdomen kit) or degrees of negative pressure (<50, 50-100, or >100 mmHg). A generalized estimating equation was used to adjust for age, BMI, comorbidities, etiology for laparotomy requiring OA, vital signs, transfusion, severity of critical illness, and institutional characteristics. RESULTS: Of the 279 included patients, 252 achieved primary fascia closure. A higher degree of negative pressure (>100 mmHg) was associated with fewer primary fascia closures than less than 50 mmHg [OR, 0.18 (95% CI: 0.50-0.69), P =0.012] and with more frequent enteroatmospheric fistula [OR, 13.83 (95% CI: 2.30-82.93)]. The methods of NPWT were not associated with successful primary fascia closure. However, the use of the open-abdomen kit was related to a lower incidence of enteroatmospheric fistula [OR, 0.02 (95% CI: 0.00-0.50)]. CONCLUSION: High negative pressure (>100 mmHg) should be avoided in NPWT during tentative abdominal closure for OA.

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Hyperoxia for accidental hypothermia and increased mortality: a post-hoc analysis of a multicenter prospective observational study

Yamamoto R., Yoshizawa J., Takauji S., Hayakawa M., Sasaki J.

Critical Care （Critical Care）  27 （ 1 ） 131 2023年12月

ISSN  13648535

　概要を見る

Background: Supraphysiologic oxygen administration causes unfavorable clinical outcomes in various diseases, including traumatic brain injury, post–cardiac arrest syndrome, and acute lung injury. Accidental hypothermia is a critical illness that reduces oxygen demands, and excessive oxygen is likely to emerge. This study aimed to determine whether hyperoxia would be associated with increased mortality in patients with accidental hypothermia. Methods: A post-hoc analysis of a nationwide multicenter prospective observational study (ICE-CRASH study) on patients with accidental hypothermia admitted in 2019–2022 was conducted. Adult patients without cardiac arrest whose core body temperature was < 32 °C and whose arterial partial pressure of oxygen (PaO2) was measured at the emergency department were included. Hyperoxia was defined as a PaO2 level of 300 mmHg or higher, and 28-day mortality was compared between patients with and without hyperoxia before rewarming. Inverse probability weighting (IPW) analyses with propensity scores were performed to adjust patient demographics, comorbidities, etiology and severity of hypothermia, hemodynamic status and laboratories on arrival, and institution characteristics. Subgroup analyses were conducted according to age, chronic cardiopulmonary diseases, hemodynamic instability, and severity of hypothermia. Results: Of the 338 patients who were eligible for the study, 65 had hyperoxia before rewarming. Patients with hyperoxia had a higher 28-day mortality rate than those without (25 (39.1%) vs. 51 (19.5%); odds ratio (OR) 2.65 (95% confidence interval 1.47–4.78); p < 0.001). IPW analyses with propensity scores revealed similar results (adjusted OR 1.65 (1.14–2.38); p = 0.008). Subgroup analyses showed that hyperoxia was harmful in the elderly and those with cardiopulmonary diseases and severe hypothermia below 28 °C, whereas hyperoxia exposure had no effect on mortality in patients with hemodynamic instability on hospital arrival. Conclusions: Hyperoxia with PaO2 levels of 300 mmHg or higher before initiating rewarming was associated with increased 28-day mortality in patients with accidental hypothermia. The amount of oxygen to administer to patients with accidental hypothermia should be carefully determined. Trial Registration: The ICE-CRASH study was registered at the University Hospital Medical Information Network Clinical Trial Registry on April 1, 2019 (UMIN-CTR ID, UMIN000036132).

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Early symptoms preceding post-infectious irritable bowel syndrome following COVID-19: a retrospective observational study incorporating daily gastrointestinal symptoms

Yamamoto R., Yamamoto A., Masaoka T., Homma K., Matsuoka T., Takemura R., Wada M., Sasaki J., Kanai T., Amagai M., Saya H., Nishihara H.

BMC Gastroenterology （BMC Gastroenterology）  23 （ 1 ） 108 - 108 2023年12月

　概要を見る

Background: Intestinal microinflammation with immune dysfunction due to severe acute respiratory syndrome coronavirus 2 reportedly precipitates post-infectious irritable bowel syndrome. This study aimed to elucidate potential risk factors for subsequent development of irritable bowel syndrome, hypothesizing that it is associated with specific symptoms or patient backgrounds. Methods: This single-center retrospective observational study (2020–2021) included adults with confirmed coronavirus disease requiring hospital admission and was conducted using real-world data retrieved from a hospital information system. Patient characteristics and detailed gastrointestinal symptoms were obtained and compared between patients with and without coronavirus disease-induced irritable bowel syndrome. Multivariate logistic models were used to validate the risk of developing irritable bowel syndrome. Moreover, daily gastrointestinal symptoms during hospitalization were examined in patients with irritable bowel syndrome. Results: Among the 571 eligible patients, 12 (2.1%) were diagnosed with irritable bowel syndrome following coronavirus disease. While nausea and diarrhea during hospitalization, elevated white blood cell count on admission, and intensive care unit admission were associated with the development of irritable bowel syndrome, nausea and diarrhea were identified as risk factors for its development following coronavirus disease, as revealed by the adjusted analyses (odds ratio, 4.00 [1.01–15.84] and 5.64 [1.21–26.31], respectively). Half of the patients with irritable bowel syndrome had both diarrhea and constipation until discharge, and constipation was frequently followed by diarrhea. Conclusions: While irritable bowel syndrome was rarely diagnosed following coronavirus disease, nausea and diarrhea during hospitalization precede the early signs of irritable bowel syndrome following coronavirus disease.

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Potential harms of emergency department thoracotomy in patients with persistent cardiac arrest following trauma: a nationwide observational study

Yamamoto R., Suzuki M., Sasaki J.

Scientific Reports 13 （ 1 ） 16042 - 16042 2023年12月

　概要を見る

Emergency department thoracotomy (EDT) was incorporated into traumatic out-of-hospital cardiac arrest (t-OHCA) resuscitation. Although current guidelines recommend EDT with survival predictors, futility following EDT has been demonstrated and the potential risks have not been thoroughly investigated. This study aimed to elucidate the benefits and harms of EDT for persistent cardiac arrest following injury until hospital arrival. This retrospective cohort study used a nationwide trauma registry (2019–2021) and included adult patients with t-OHCA both at the scene and on hospital arrival. Survival to discharge, hemostatic procedure frequency, and transfusion amount were compared between patients treated with and without EDT. Inverse probability weighting using a propensity score was conducted to adjust age, sex, comorbidities, mechanism of injury, prehospital resuscitative procedure, prehospital physician presence, presence of signs of life, degree of thoracic injury, transportation time, and institutional characteristics. Among 1289 patients, 374 underwent EDT. The longest transportation time for survivors was 8 and 23 min in patients with and without EDT, respectively. EDT was associated with lower survival to discharge (4/374 [1.1%] vs. 22/915 [2.4%]; adjusted odds ratio [OR], 0.43 [95% CI 0.22–0.84]; p = 0.011), although patients with EDT underwent more frequent hemostatic surgeries (46.0% vs. 5.0%; adjusted OR, 16.39 [95% CI 12.50–21.74]) and received a higher amount of transfusion. Subgroup analyses revealed no association between EDT and lower survival in patients with severe chest injuries (1.0% vs. 1.4%; adjusted OR, 0.72 [95% CI 0.28–1.84]). EDT was associated with lower survival till discharge in trauma patients with persistent cardiac arrests after adjusting for various patient backgrounds, including known indications for EDT. The idea that EDT is the last resort for t-OHCA should be reconsidered and EDT indications need to be deliberately determined. Trial registration This study is retrospectively registered at University Hospital Medical Information Network (UMIN ID: UMIN000050840).

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新型コロナウイルス感染症の真菌感染合併リスクの検討

前島 克哉, 山元 良, 松村 一希, 遠藤 彰, 田上 隆, 山川 一馬, 早川 峰司, 小倉 崇以, 平山 敦士, 康永 秀生, 佐々木 淳一

日本救急医学会雑誌 （(一社)日本救急医学会）  34 （ 12 ） 725 - 725 2023年12月

ISSN  0915-924X

外傷性院外心肺停止におけるSigns of lifeの意義

山下 幾太郎, 山元 良, 鈴木 昌, 北村 伸哉, 田上 隆, 康永 秀生, 武田 宗和, 麻生 将太郎, 多村 知剛, 本間 康一郎, 佐々木 淳一

日本救急医学会雑誌 （(一社)日本救急医学会）  34 （ 12 ） 722 - 722 2023年12月

ISSN  0915-924X

外傷性院外心肺停止におけるSigns of lifeの意義

山下 幾太郎, 山元 良, 鈴木 昌, 北村 伸哉, 田上 隆, 康永 秀生, 武田 宗和, 麻生 将太郎, 多村 知剛, 本間 康一郎, 佐々木 淳一

日本救急医学会雑誌 （(一社)日本救急医学会）  34 （ 12 ） 722 - 722 2023年12月

ISSN  0915-924X

新型コロナウイルス感染症の真菌感染合併リスクの検討

前島 克哉, 山元 良, 松村 一希, 遠藤 彰, 田上 隆, 山川 一馬, 早川 峰司, 小倉 崇以, 平山 敦士, 康永 秀生, 佐々木 淳一

日本救急医学会雑誌 （(一社)日本救急医学会）  34 （ 12 ） 725 - 725 2023年12月

ISSN  0915-924X

院外心停止患者における自己心拍再開直後の高酸素血症と神経学的予後の関連

山中 隆広, 山元 良, 小笠原 智子, 北村 伸哉, 田上 隆, 康永 秀生, 麻生 将太郎, 武田 宗和, 多村 知剛, 本間 康一郎, 佐々木 淳一

日本救急医学会雑誌 （(一社)日本救急医学会）  34 （ 12 ） 702 - 702 2023年12月

ISSN  0915-924X

院外心停止患者における自己心拍再開直後の高酸素血症と神経学的予後の関連

山中 隆広, 山元 良, 小笠原 智子, 北村 伸哉, 田上 隆, 康永 秀生, 麻生 将太郎, 武田 宗和, 多村 知剛, 本間 康一郎, 佐々木 淳一

日本救急医学会雑誌 （(一社)日本救急医学会）  34 （ 12 ） 702 - 702 2023年12月

ISSN  0915-924X

老健施設内の心停止患者における神経予後の検討

大野 聡一郎, 山元 良, 多村 知剛, 本間 康一郎, 佐々木 淳一, 杉山 和宏, 北村 伸哉, 田上 隆, 康永 秀生, 麻生 将太郎, 武田 宗和

日本救急医学会雑誌 （(一社)日本救急医学会）  34 （ 12 ） 702 - 702 2023年12月

ISSN  0915-924X

老健施設内の心停止患者における神経予後の検討

大野 聡一郎, 山元 良, 多村 知剛, 本間 康一郎, 佐々木 淳一, 杉山 和宏, 北村 伸哉, 田上 隆, 康永 秀生, 麻生 将太郎, 武田 宗和

日本救急医学会雑誌 （(一社)日本救急医学会）  34 （ 12 ） 702 - 702 2023年12月

ISSN  0915-924X

病院前でのshockable rhythmは心原性心停止を示唆し転帰と関連するか

小川 広晃, 多村 知剛, 立石 順久, 北村 伸哉, 田上 隆, 康永 秀生, 麻生 将太郎, 武田 宗和, 山元 良, 本間 康一郎, 佐々木 淳一

日本救急医学会雑誌 （(一社)日本救急医学会）  34 （ 12 ） 751 - 751 2023年12月

ISSN  0915-924X

病院前でのshockable rhythmは心原性心停止を示唆し転帰と関連するか

小川 広晃, 多村 知剛, 立石 順久, 北村 伸哉, 田上 隆, 康永 秀生, 麻生 将太郎, 武田 宗和, 山元 良, 本間 康一郎, 佐々木 淳一

日本救急医学会雑誌 （(一社)日本救急医学会）  34 （ 12 ） 751 - 751 2023年12月

ISSN  0915-924X

早期緊急通報の転帰に及ぼす影響

笠茂 修平, 山元 良, 舩越 拓, 北村 伸哉, 田上 隆, 康永 秀生, 麻生 将太郎, 武田 宗和, 山下 幾太郎, 多村 知剛, 本間 康一郎, 佐々木 淳一

日本救急医学会雑誌 （(一社)日本救急医学会）  34 （ 12 ） 703 - 703 2023年12月

ISSN  0915-924X

早期緊急通報の転帰に及ぼす影響

笠茂 修平, 山元 良, 舩越 拓, 北村 伸哉, 田上 隆, 康永 秀生, 麻生 将太郎, 武田 宗和, 山下 幾太郎, 多村 知剛, 本間 康一郎, 佐々木 淳一

日本救急医学会雑誌 （(一社)日本救急医学会）  34 （ 12 ） 703 - 703 2023年12月

ISSN  0915-924X

Early restricted oxygen therapy after resuscitation from cardiac arrest (ER-OXYTRAC): Protocol for a stepped-wedge cluster randomised controlled trial

Yamamoto R., Yamakawa K., Endo A., Homma K., Sato Y., Takemura R., Yamagiwa T., Shimizu K., Kaito D., Yagi M., Yonemura T., Shibusawa T., Suzuki G., Shoji T., Miura N., Takahashi J., Narita C., Kurata S., Minami K., Wada T., Fujinami Y., Tsubouchi Y., Natsukawa M., Nagayama J., Takayama W., Ishikura K., Yokokawa K., Fujita Y., Nakayama H., Tokuyama H., Shinada K., Taira T., Fukui S., Ushio N., Nakane M., Hoshiyama E., Tampo A., Sageshima H., Takami H., Iizuka S., Kikuchi H., Hagiwara J., Tagami T., Funato Y., Sasaki J., Er-Oxytrac S.G.

BMJ Open 13 （ 9 ） e074475 2023年09月

　概要を見る

Introduction Cardiac arrest is a critical condition, and patients often experience postcardiac arrest syndrome (PCAS) even after the return of spontaneous circulation (ROSC). Administering a restricted amount of oxygen in the early phase after ROSC has been suggested as a potential therapy for PCAS; however, the optimal target for arterial partial pressure of oxygen or peripheral oxygen saturation (SpO 2) to safely and effectively reduce oxygen remains unclear. Therefore, we aimed to validate the efficacy of restricted oxygen treatment with 94%-95% of the target SpO 2 during the initial 12 hours after ROSC for patients with PCAS. Methods and analysis ER-OXYTRAC (early restricted oxygen therapy after resuscitation from cardiac arrest) is a nationwide, multicentre, pragmatic, single-blind, stepped-wedge cluster randomised controlled trial targeting cases of non-traumatic cardiac arrest. This study includes adult patients with out-of-hospital or in-hospital cardiac arrest who achieved ROSC in 39 tertiary centres across Japan, with a target sample size of 1000. Patients whose circulation has returned before hospital arrival and those with cardiac arrest due to intracranial disease or intoxication are excluded. Study participants are assigned to either the restricted oxygen (titration of a fraction of inspired oxygen with 94%-95% of the target SpO 2) or the control (98%-100% of the target SpO 2) group based on cluster randomisation per institution. The trial intervention continues until 12 hours after ROSC. Other treatments for PCAS, including oxygen administration later than 12 hours, can be determined by the treating physicians. The primary outcome is favourable neurological function, defined as cerebral performance category 1-2 at 90 days after ROSC, to be compared using an intention-to-treat analysis. Ethics and dissemination This study has been approved by the Institutional Review Board at Keio University School of Medicine (approval number: 20211106). Written informed consent will be obtained from all participants or their legal representatives. Results will be disseminated via publications and presentations. Trial registration number UMIN Clinical Trials Registry (UMIN000046914).

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Cushing Index Based on Cushing Signs to Predict In-Hospital Death and Early Intervention for Minor Head Injury.

Matsumura K, Yamamoto R, Namiki J, Takemura R, Sasaki J

Journal of neurotrauma 40 （ 19-20 ） 2110 - 2117 2023年07月

ISSN  0897-7151

　概要を見る

A considerable number of patients with mild traumatic brain injury have been known to ‘‘talk and die.’’ Serial neurological examinations, however, have been the only method of determining the necessity of repeat computed tomography (CT), and no validated method has been available to predict early deterioration of minor head injury. This study aimed to evaluate the association between hypertension and bradycardia, a classic sign of raised intracranial pressure (Cushing reflex) on hospital arrival and determine the clinical consequences of minor head injury after blunt trauma. We created a new Cushing Index (CI) by dividing the systolic blood pressure by the heart rate (equaling the inverse number of the Shock Index, a score for hemodynamic stability) and hypothesized that a high CI would predict surgical intervention for deterioration and in-hospital death among patients with minor head injury. To test our hypothesis, a retrospective observational study was conducted using a nationwide trauma database. Accordingly, adult blunt trauma with minor head injury (defined as a Glasgow Coma Scale of 13–15 and Abbreviated Injury Scale score of ‡2 in the head) who were transported directly from the scene by ambulances were included. Among the 338,744 trauma patients identified in the database, 38,844 were eligible for inclusion. A restricted cubic spline regression curve for risks of in-hospital death was created using the CI. Thereafter, the thresholds were determined based on inflection points of the curve, and patients were divided into low-, intermediate-, and high-CI groups. Patients with high CI showed significantly higher in-hospital mortality rates compared with those with intermediate CI (351 [3.0%] vs. 373 [2.3%]; odds ratio [OR] = 1.32 [1.14–1.53]; p < 0.001). Patients with high index also had a higher incidence of emergency cranial surgery within 24h after arrival than those with an intermediate CI (746 [6.4%] vs. 879 [5.4%]; OR = 1.20 [1.08–1.33]; p < 0.001). In addition, patients with low CI (equal to high Shock Index, meaning hemodynamically unstable) showed higher in-hospital death compared with those with intermediate CI (360 [3.3%] vs. 373 [2.3%]; p < 0.001). In conclusion, a high CI (high systolic blood pressure and low heart rate) on hospital arrival would be helpful in identifying patients with minor head injury who might experience deterioration and need close observation.

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遅発性上気道狭窄を伴った外傷性後咽頭間隙血腫の一例

大島 千穂, 山元 良, 西田 有正, 大野 聡一郎, 宇田川 和彦, 栗原 智宏, 佐々木 淳一

日本外傷学会雑誌 （一般社団法人 日本外傷学会）  37 （ 3 ） 319 - 323 2023年07月

ISSN  13406264

　概要を見る

<p>　症例は76歳の男性で, 飲酒後に転倒し, 当院へ搬送された. 頸部CTで後咽頭間隙血腫を認めたが, 呼吸困難や酸素化低下などはなかった. 受傷5日目にStridorと酸素化低下が出現し, 気管支鏡で後咽頭間隙血種による気管後壁の圧排所見を認め, 上気道狭窄に至った. 気管支鏡下にて気管挿管を施行し, 呼吸状態および低酸素血症は速やかに改善した. 第12病日に人工呼吸器離脱し, 第46病日に自宅退院した. 後咽頭間隙血腫は比較的稀な外傷であるが, 転倒外傷において, 初療時に上気道狭窄症状のない後咽頭間隙血腫が受傷5日目に急速に増悪し気道狭窄に至ることは極めて稀である. 初療時に上気道狭窄症状がなくても, 数日以上の経過観察を行う必要性が示唆された.</p>

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Healthcare costs for hospitalized COVID-19 patients in a Japanese university hospital: a cross-sectional study.

Uno S, Goto R, Honda K, Tokuda M, Kamata H, Chubachi S, Yamamoto R, Sato Y, Homma K, Uchida S, Namkoong H, Uwamino Y, Sasaki J, Fukunaga K, Hasegawa N

Cost effectiveness and resource allocation : C/E 21 （ 1 ） 43 - 43 2023年07月

ISSN  1478-7547

　概要を見る

Background: A health-economic evaluation related to COVID-19 is urgently needed to allocate healthcare resources efficiently; however, relevant medical cost data in Japan concerning COVID-19 are scarce. Methods: This cross-sectional study investigated the healthcare cost for hospitalized COVID-19 patients in 2021 at Keio University Hospital. We calculated the healthcare costs during hospitalization using hospital claims data and investigated the variables significantly related to the healthcare cost with multivariable analysis. Results: The median healthcare cost per patient for the analyzed 330 patients was Japanese yen (JPY) 1,304,431 (US dollars ~ 11,871) (interquartile range: JPY 968,349–1,954,093), and the median length of stay was 10 days. The median healthcare cost was JPY 798,810 for mild cases; JPY 1,113,680 for moderate I cases; JPY 1,643,909 for moderate II cases; and JPY 6,210,607 for severe cases. Healthcare costs increased by 4.0% for each additional day of hospitalization; 1.26 times for moderate I cases, 1.64 times for moderate II cases, and 1.84 times for severe cases compared to mild cases; and 2.05 times for cases involving ICU stay compared to those not staying in ICU. Conclusions: We clarified the healthcare cost for hospitalized COVID-19 patients by severity in a Japanese university hospital. These costs contribute as inputs for forthcoming health economic evaluations for strategies for preventing and treating COVID-19.

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Frailty and Neurologic Outcomes of Patients Resuscitated From Nontraumatic Out-of-Hospital Cardiac Arrest: A Prospective Observational Study

Yamamoto R., Tamura T., Haiden A., Yoshizawa J., Homma K., Kitamura N., Sugiyama K., Tagami T., Yasunaga H., Aso S., Takeda M., Sasaki J.

Annals of Emergency Medicine （Annals of Emergency Medicine）  82 （ 1 ） 84 - 93 2023年07月

ISSN  01960644

　概要を見る

Study objective: To elucidate the clinical utility of the Clinical Frailty Scale score for predicting poor neurologic functions in patients resuscitated from out-of-hospital cardiac arrest (OHCA). Methods: This was a prospective, multicenter, observational study conducted between 2019 and 2021. The study included adults with nontraumatic OHCA admitted to the intensive care unit after return of spontaneous circulation (ROSC). Pre-arrest high Clinical Frailty Scale score was defined as 5 or more. Favorable neurologic outcomes defined as a Cerebral Performance Category score of 2 or less at 30 days after admission were compared between patients with and without high Clinical Frailty Scale scores. Multivariable logistic regression analyses fitted with generalized estimating equations were performed to adjust for patient characteristics, out-of-hospital information, and resuscitation content and account for within-institution clustering. Results: Of 9,909 patients with OHCA during the study period, 1,216 were included, and 317 had a pre-arrest high Clinical Frailty Scale score. Favorable neurologic outcomes were fewer among patients with high Clinical Frailty Scale scores. The high Clinical Frailty Scale score group showed a lower percentage of favorable neurologic outcomes after OHCA than the low Clinical Frailty Scale score group (6.1% vs 24.4%; adjusted odds ratio, 0.45 [95% confidence interval 0.22 to 0.93]). This relationship remained in subgroups with cardiogenic OHCA, with ROSC after hospital arrival, and without a high risk of dying (Clinical Frailty Scale score of 7 or less), whereas the neurologic outcomes were comparable regardless of pre-arrest frailty in those with noncardiogenic OHCA and with ROSC before hospital arrival. Conclusions: Pre-arrest high Clinical Frailty Scale score was associated with unfavorable neurologic functions among patients resuscitated from OHCA. The Clinical Frailty Scale score would help predict clinical consequences following intensive care after ROSC.

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Hypotension at Hospital Presentation and Post-Contrast Acute Kidney Injury following Computed Tomography with Contrast Media

Yoshizawa J., Yamamoto R., Homma K., Kamikura H., Sekine K., Kobayashi Y., Funabiki T., Sasaki J.

Nephron （Nephron）  147 （ 3-4 ） 170 - 176 2023年04月

ISSN  16608151

　概要を見る

Introduction: Post-contrast acute kidney injury (PC-AKI) is a major complication of contrast media usage; risks for PC-AKI are generally evaluated before computed tomography (CT) with contrast at the emergency department (ED). Although persistent hypotension (systolic blood pressure [sBP] <80 mm Hg for 1 h) is associated with increased PC-AKI incidence, it remains unclear whether transient hypotension that is haemodynamically stabilized before CT is a risk of PC-AKI. We hypothesized that hypotension on ED arrival would be associated with higher PC-AKI incidence even if CT with contrast was performed after patients are appropriately resuscitated. Methods: This multicentre retrospective observational study was conducted at three tertiary care centres during 2013-2014. We identified 280 patients who underwent CT with contrast at the ED. Patients were classified into two groups based on sBP on arrival (<80 vs. ≥80 mm Hg); hypotension was considered as transient because CT with contrast has always been performed after patients were stabilized at participating hospitals. PC-AKI incidence was compared between the groups; inverse probability weighting (IPW) was conducted to adjust background characteristics. Results: Eighteen patients were excluded due to chronic haemodialysis, cardiac arrest on arrival, or death within 72 h; 262 were eligible for this study. PC-AKI incidence was higher in the transient hypotension group than the normotension group {7/27 (28.6%) vs. 24/235 (10.2%), odds ratio (OR) 3.08 (95% confidence interval [CI] 1.18-8.03), p = 0.026}, which was confirmed by IPW (OR 3.25 [95% CI 1.99-5.29], p < 0.001). Conclusion: Transient hypotension at the ED was associated with PC-AKI development.

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Immediate CT after hospital arrival and decreased in-hospital mortality in severely injured trauma patients.

Yamamoto R, Suzuki M, Funabiki T, Sasaki J

BJS open 7 （ 1 ）  2023年01月

　概要を見る

Background: Immediate whole-body CT (about 10 min after arrival) in an all-in-one resuscitation room equipped with CT has been found to be associated with shorter time to haemostasis and lower in-hospital mortality. The aim of this study was to elucidate the benefits of immediate whole-body CT after hospital arrival in patients with severe trauma with the hypothesis that immediate CT within 10 min is associated with lower in-hospital mortality. Method: This retrospective cohort study of patients with an injury severity score of more than 15 who underwent whole-body CT was conducted using the Japanese Trauma Databank (2019–2020). An immediate CT was conducted within 10 min after arrival. In-hospital mortality, frequency of subsequent surgery, and time to surgery were compared with immediate and non-immediate CT. Inverse probability weighting was conducted to adjust for patient backgrounds, including mechanism and severity of injury, prehospital treatment, vital signs, and institutional characteristics. Results: Among the 7832 patients included, 646 underwent immediate CT. Immediate CT was associated with lower in-hospital mortality (12.5 versus 15.7 per cent; adjusted OR 0.77 (95 per cent c.i. 0.69 to 0.84); P < 0.001) and fewer damage-control surgeries (OR 0.75 (95 per cent c.i. 0.65 to 0.87)). There was a 10 to 20 min difference in median time to craniotomy, laparotomy, and angiography. These benefits were observed regardless of haemodynamic instability on hospital arrival, while they were identified only in elderly patients with severe injury and altered consciousness. Conclusion: Immediate CT within 10 min after arrival was associated with decreased in-hospital mortality in severely injured trauma patients.

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Combined Ankle Robot Training and Robot-assisted Gait Training Improved the Gait Pattern of a Patient with Chronic Traumatic Brain Injury.

Kamimoto T, Hosoi Y, Tanamachi K, Yamamoto R, Yamada Y, Teramae T, Noda T, Kaneko F, Tsuji T, Kawakami M

Progress in rehabilitation medicine 8   20230024 2023年

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Hydrogen gas and preservation of intestinal stem cells in mesenteric ischemia and reperfusion.

Yamamoto R, Suzuki S, Homma K, Yamaguchi S, Sujino T, Sasaki J

World journal of gastrointestinal surgery 14 （ 12 ） 1329 - 1339 2022年12月

ISSN  1948-9366

　概要を見る

BACKGROUND: Patients with mesenteric ischemia frequently suffer from bowel necrosis even after revascularization. Hydrogen gas has showed promising effects for ischemia-reperfusion injury by reducing reactive oxygen species in various animal and clinical studies. We examined intestinal tissue injury by ischemia and reperfusion under continuous initiation of 3% hydrogen gas. AIM: To clarify the treatment effects and target cells of hydrogen gas for mesenteric ischemia. METHODS: Three rat groups underwent 60-min mesenteric artery occlusion (ischemia), 60-min reperfusion following 60-min occlusion (reperfusion), or ischemia-reperfusion with the same duration under continuous 3% hydrogen gas inhalation (hydrogen). The distal ileum was harvested. Immunofluorescence staining with caspase-3 and leucine-rich repeat-containing G-protein-coupled 5 (LGR5), a specific marker of intestinal stem cell, was conducted to evaluate the injury location and cell types protected by hydrogen. mRNA expressions of LGR5, olfactomedin 4 (OLFM4), hairy and enhancer of split 1, Jagged 2, and Neurogenic locus notch homolog protein 1 were measured by quantitative polymerase chain reaction. Tissue oxidative stress was analyzed with immunostaining for 8-hydroxy-2'-deoxyguanosine (8-OHdG). Systemic oxidative stress was evaluated by plasma 8-OHdG. RESULTS: Ischemia damaged the epithelial layer at the tip of the villi, whereas reperfusion induced extensive apoptosis of the cells at the crypt base, which were identified as intestinal stem cells with double immunofluorescence stain. Hydrogen mitigated such apoptosis at the crypt base, and the LGR5 expression of the tissues was higher in the hydrogen group than in the reperfusion group. OLFM4 was also relatively higher in the hydrogen group, whereas other measured RNAs were comparable between the groups. 8-OHdG concentration was high in the reperfusion group, which was reduced by hydrogen, particularly at the crypt base. Serum 8-OHdG concentrations were relatively higher in both reperfusion and hydrogen groups without significance. CONCLUSION: This study demonstrated that hydrogen gas inhalation preserves intestinal stem cells and mitigates oxidative stress caused by mesenteric ischemia and reperfusion.

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Trauma-Angio score as a predictor of urgent angioembolization for blunt trauma: development and validation using independent cohorts

Maeshima K., Yamamoto R., Sasaki J.

European Journal of Trauma and Emergency Surgery （European Journal of Trauma and Emergency Surgery）  48 （ 6 ） 4837 - 4845 2022年12月

ISSN  18639933

　概要を見る

Purpose: This research aimed to establish a scoring system for selecting candidates for urgent angioembolization (AE). Methods: Patients with blunt trauma were retrospectively identified in a nationwide trauma registry. Patients aged ≥ 15 years with a systolic blood pressure of ≥90 mmHg were included. These individuals were then categorized into development and validation cohorts based on the date of admission. Next, an eight-point scaled system was developed using odds ratios obtained from the multivariate analysis of patients’ clinical factors on their arrival at the hospital, with the implementation of urgent AE as a dependent variable. Results: The development cohort and validation cohort included 158,192 and 116,941 patients, respectively, and 3296 (2.1%) patients in the development cohort and 2,550 (2.2%) patients in the validation cohort underwent urgent AE. The frequency of transfusion within 24 h after arrival and the Injury Severity Score were similar between the two cohorts (16,867 [10.7%] vs. 11,222 [9.6%] and 10 [9–18] vs. 10 [9–17], respectively). The number of patients who were discharged and hospital-free days were comparable between the two cohorts (139,436 [94.4%] vs. 106,107 [95.6%] and 72 [53–84] vs. 73 [57–84] days, respectively). The probabilities and the observed rates of urgent AE increased proportionally from 2% at a score of ≤ 3 to almost 15% at a score of ≥ 7. In terms of predictive factors, no significant interaction was noted. Conclusion: The Trauma-Angio scoring system can be used as a trigger to suggest the possibility of urgent AE. Trial Registration: 20090087, 31st July 2009.

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Optimal target blood pressure in elderly with septic shock (OPTPRESS) trial: study protocol for a randomized controlled trial

Endo A., Yamakawa K., Tagami T., Umemura Y., Takahashi K., Nagasawa H., Araki Y., Kojima M., Sera T., Yagi M., Yamamoto R., Takahashi J., Nakane M., Takeda C., Narita C., Kazuma S., Okura H., Takahashi H., Wada T., Tahara S., Matsuoka A., Masaki T., Shiraishi A., Shimoyama K., Yokokawa Y., Nakamura R., Sageshima H., Yanagida Y., Takahashi K., Otomo Y.

Trials （Trials）  23 （ 1 ） 799 2022年12月

　概要を見る

Background: Hemodynamic stabilization is a core component in the resuscitation of septic shock. However, the optimal target blood pressure remains debatable. Previous randomized controlled trials suggested that uniformly adopting a target mean arterial pressure (MAP) higher than 65 mmHg for all adult septic shock patients would not be beneficial; however, it has also been proposed that higher target MAP may be beneficial for elderly patients, especially those with arteriosclerosis. Methods: A multicenter, pragmatic single-blind randomized controlled trial will be conducted to compare target MAP of 80–85 mmHg (high-target) and 65–70 mmHg (control) in the resuscitation of septic shock patients admitted to 28 hospitals in Japan. Patients with septic shock aged ≥65 years are randomly assigned to the high-target or control groups. The target MAP shall be maintained for 72 h after randomization or until vasopressors are no longer needed to improve patients’ condition. To minimize the adverse effects related to catecholamines, if norepinephrine dose of ≥ 0.1 μg/kg/min is needed to maintain the target MAP, vasopressin will be initiated. Other therapeutic approaches, including fluid administration, hydrocortisone use, and antibiotic choice, will be determined by the physician in charge based on the latest clinical guidelines. The primary outcome is all-cause mortality at 90 days after randomization. Discussion: The result of this trial will provide great insight on the resuscitation strategy for septic shock in the era of global aged society. Also, it will provide the better understanding on the importance of individualized treatment strategy in hemodynamic management in critically ill patients. Trial registration: UMIN Clinical Trials Registry; UMIN000041775. Registered 13 September 2020.

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Incisional wound closure by sequential partial split-thickness skin grafting following failure of primary abdominal fascia closure after open abdomen management: A case report

Suzuki S., Yamamoto R., Hori S., Kitago M., Kitagawa Y., Sasaki J.

International Journal of Surgery Case Reports （International Journal of Surgery Case Reports）  101   107802 2022年12月

ISSN  22102612

　概要を見る

Introduction: Open abdomen (OA) is a widely used technique for managing abdominal organ injury, abdominal compartment syndrome, and abdominal sepsis. While various methods have contributed to successful primary closure of the abdominal fascia after OA, some patients still develop enteroatmospheric fistulas that impede abdominal fascia closure. We report a case of successful epithelialization of the incision by sequential partial split-thickness skin grafting (STSG) in a patient who had failure in primary abdominal fascia closure due to enteroatmospheric fistulas after OA for incisional dehiscence and anastomotic leakage. Presentation of case: A 73-year-old male patient underwent pancreaticoduodenectomy for duodenal adenocarcinoma. The abdominal incision was then necrosed and dehisced due to anastomotic leakage on postoperative day (POD) 6, and multiple intra-abdominal lavages with OA were performed. On POD 15, the patient developed enteroatmospheric fistulas; thus, primary fascia closure was considered impossible. On PODs 72 and 106, STSG was conducted on the granulation tissue at the incisional wound, and complete epithelialization was achieved on POD 111. Discussion: Sequential partial STSG only needed basic surgical skills and standard devices for surgery. Conclusion: We reported the case with successful epithelialization of the incision by sequential partial STSG, in which primary abdominal fascia closure was failed due to enteroatmospheric fistulas after OA for incisional dehiscence and anastomotic leakage.

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Extracorporeal cardiopulmonary resuscitation in adult patients with out-of-hospital cardiac arrest: a retrospective large cohort multicenter study in Japan

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 S.i., 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., Senda A., Suzuki H., Tanimoto A., Kitagawa K., Katayama Y., Igarashi N., Kawano M., Kuroki Y., Umehara T., Sasaki Y., Tominaga N., Hamaguchi T., Sakai T., Abe T., Hanafusa H., Yamaoka Y., Kakizaki Y., Sakato S., Kashiwabara S., Kadoya T., Misumi K., Kobayashi T., Yamada S., Kobayashi M., Akashi N., Kuno M., Maruyama J., Kobata H., Soh M., Shirasaki K., Shiba D., Isokawa S., Uchida M., Sakurai A., Tatsukawa H., Nishikawa M., Kojima M., Kosaki R., Shimazui T., Kinoshita H., Sawada Y., Yamamoto R., Masuzawa Y., Matsumura K., Shimazaki J.

Critical Care （Critical Care）  26 （ 1 ）  2022年12月

ISSN  13648535

　概要を見る

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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Early intubation and decreased in-hospital mortality in patients with coronavirus disease 2019

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.

Critical Care （Critical Care）  26 （ 1 ） 124 - 124 2022年12月

ISSN  13648535

　概要を見る

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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Characteristics of Laparoscopic Surgery for Trauma Patients and Risks of Conversion to Open Laparotomy

Yamamoto R., Cestero R.F., Kameyama N., Sasaki J.

World Journal of Surgery （World Journal of Surgery）  46 （ 11 ） 2616 - 2624 2022年11月

ISSN  03642313

　概要を見る

Background: The discussion is ongoing about appropriate indications for laparoscopic surgery in trauma patients. As timing and risks of conversion to laparotomy remain unclear, we aimed to elucidate characteristics of and risks for conversion following laparoscopic surgery, using a nationwide database. Methods: A retrospective observational study was conducted, using Japanese Trauma Data Bank (2004–2018). We included adult trauma patients who underwent laparoscopic surgery as an initial surgical intervention. Conversion to laparotomy was defined as laparotomy at the initial surgery. Patient demographics, mechanism and severity of injury, injured organs, timing of surgery, and clinical outcomes were compared between patients with and without conversion. Risks for conversion were analyzed focusing on indications for laparoscopic surgery, after adjusting patient and institution characteristics. Results: Among 444 patients eligible for the study, 31 required conversions to laparotomy. The number of laparoscopic surgeries gradually increased over the study period (0.5–4.5% of trauma laparotomy), without changes in conversion rates (5–10%). Patients who underwent conversion had more severe abdominal injuries compared with those who did not (AIS 3 vs 2). While length of hospital stay and in-hospital mortality were comparable, abdominal complications were higher among patients with conversion (12.9 vs. 2.9%), particularly when laparoscopy was performed for peritonitis (OR, 22.08 [5.11–95.39]). A generalized estimating equation model adjusted patient background and identified hemoperitoneum and peritoneal penetration as risks for conversion (OR, 24.07 [7.35–78.75] and 8.26 [1.20– 56.75], respectively). Conclusions: Trauma laparoscopy for hemoperitoneum and peritoneal penetration were associated with higher incidence of conversion to open laparotomy.

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D-dimer for screening of aortic dissection in patients with ST-elevation myocardial infarction

Kaito D., Yamamoto R., Nakama R., Hashizume K., Ueno K., Sasaki J.

American Journal of Emergency Medicine （American Journal of Emergency Medicine）  59   146 - 151 2022年09月

ISSN  07356757

　概要を見る

Background: Acute aortic dissection (AAD) with concurrent ST-segment elevation myocardial infarction (STEMI) is relatively rare and sometimes overlooked. As D-dimer testing has been reported to have high sensitivity to diagnose AAD in a clinical scale, Aortic Dissection Detection Risk Score (ADD-RS), a point-of-care D-dimer analyzer capable of measuring in 10 min would be useful to deny AAD with concurrent STEMI. However, an optimal cut-off value of D-dimer in such population remains unclear. Therefore, the aim of this study was to elucidate the optimal D-dimer threshold in patients clinically diagnosed with STEMI. Methods: This retrospective cohort study was conducted at two tertiary care centers between 2014 and 2019. Patients clinically diagnosed with STEMI who underwent serum D-dimer measurement on hospital arrival were included. The primary outcome was the diagnosis of AAD. The area under the receiver operating characteristic curve (AUROC) for D-dimer values to diagnose AAD was evaluated, particularly in patients with low to moderate risks of AAD (1 of ADD-RS). The sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were calculated with several cut-off values. Results: A total of 322 patients were included, and 28 were diagnosed with AAD. The AUROC for D-dimer to diagnose AAD was 0.970 (95% confidence interval: 0.948–0.993) in 262 patients with 1 of ADD-RS. If D-dimer ≥750 ng/mL was used as a cut-off value, sensitivity, specificity, PPV and NPV were 100%, 86.4%, 37.7%, and 100%, respectively. AAD could be denied in 209 (79.8%) patients using the cut-off value (D-dimer <750 ng/mL). Conclusions: Serum D-dimer ≥750 ng/mL exhibited high sensitivity and NPV to diagnose AAD with concurrent STEMI, while the ADD-RS originally utilized ≥500 ng/mL as a cut-off for any suspected AAD. A point-of-care D-dimer measurement with the new cut-off would be useful to rule-out AAD among patients with STEMI.

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Gaining or wasting time? Influence of time to operating room on mortality after temporary hemostasis using resuscitative endovascular balloon occlusion of the aorta

Yamamoto R., Alarhayem A., Muir M.T., Jenkins D.H., Eastridge B.J., Shapiro M.L., Cestero R.F.

American Journal of Surgery （American Journal of Surgery）  224 （ 1 ） 125 - 130 2022年07月

ISSN  00029610

　概要を見る

Background: The optimal candidates for resuscitative endovascular balloon occlusion of the aorta (REBOA) remains unclear. We hypothesized patients with delayed transfer to operating room (OR) would benefit from REBOA. Methods: Using the 2016–2017 ACS-TQIP database, patients were divided based on the transfer time to OR: ≤1 h (early) and >1 h (delayed). In each group, patients who underwent REBOA in emergency department (ED-REBOA) were matched with those without REBOA (non-REBOA) using propensity scores, and survival to discharge was compared. Results: Among 163,453 patients, 114 and 138 patients (38 and 46 ED-REBOA) were included in the early and delayed groups, respectively. Survival to discharge was comparable between ED-REBOA and non-REBOA patients in the early group (39.5% vs. 48.7%, p = 0.35), whereas it was higher in ED-REBOA patients in the delayed group (39.1% vs. 12.0%, p < 0.01). Conclusions: Patients with delayed transfer to OR >1 h benefited from REBOA.

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Threshold of increase in oxygen demand to predict mechanical ventilation use in novel coronavirus disease 2019: A retrospective cohort study incorporating restricted cubic spline regression

Yamamoto R., Takemura R., Yamamoto A., Matsumura K., Kaito D., Homma K., Wada M., Sasaki J.

PLoS ONE （PLoS ONE）  17 （ 7 July ） e0269876 2022年07月

　概要を見る

Background Rapid deterioration of oxygenation occurs in novel coronavirus disease 2019 (COVID-19), and prediction of mechanical ventilation (MV) is needed for allocation of patients to intensive care unit. Since intubation is usually decided based on varying clinical conditions, such as required oxygen changes, we aimed to elucidate thresholds of increase in oxygen demand to predict MV use within 12 h. Methods A single-center retrospective cohort study using data between January 2020 and January 2021was conducted. Data were retrieved from the hospital data warehouse. Adult patients diagnosed with COVID-19 with a positive polymerase chain reaction (PCR) who needed oxygen during admission were included. Hourly increments in oxygen demand were calculated using two consecutive oxygen values. Covariates were selected from measurements at the closest time points of oxygen data. Prediction of MV use within 12 h by required oxygen changes was evaluated with the area under the receiver operating curves (AUCs). A threshold for increased MV use risk was obtained from restricted cubic spline curves. Results Among 66 eligible patients, 1835 oxygen data were analyzed. The AUC was 0.756 for predicting MV by oxygen demand changes, 0.888 by both amounts and changes in oxygen, and 0.933 by the model adjusted with respiratory rate, PCR quantification cycle (Ct), and days from PCR. The threshold of increments of required oxygen was identified as 0.44 L/ min/h and the probability of MV use linearly increased afterward. In subgroup analyses, the threshold was lower (0.25 L/min/h) when tachypnea or frequent respiratory distress existed, whereas it was higher (1.00 L/min/h) when viral load is low (Ct ≥20 or days from PCR >7 days). Conclusions Hourly changes in oxygen demand predicted MV use within 12 h, with a threshold of 0.44 L/ min/h. This threshold was lower with an unstable respiratory condition and higher with a low viral load.

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Risk factors for peripheral intravascular catheter-related phlebitis in critically ill patients: analysis of 3429 catheters from 23 Japanese intensive care units.

Yasuda H, Rickard CM, Marsh N, Yamamoto R, Kotani Y, Kishihara Y, Kondo N, Sekine K, Shime N, Morikane K, Abe T, AMOR-NUS study group

Annals of intensive care 12 （ 1 ） 33 - 33 2022年04月

ISSN  2110-5820

　概要を見る

BACKGROUND: Phlebitis is an important complication occurring in patients with peripheral intravascular catheters (PIVCs). The risk factors for phlebitis in the intensive care unit (ICU) was examined. METHODS: A secondary analysis of a prospective multicenter cohort study was conducted, involving 23 ICUs in Japan-the AMOR-VENUS study. Consecutive patients aged ≥ 18 years admitted to the ICU with newly inserted PIVCs after ICU admission were enrolled. Characteristics of the ICU, patients, PIVCs, and the drugs administered via PIVCs were recorded. A marginal Cox regression model was used to identify the risk factors associated with phlebitis. RESULTS: A total of 2741 consecutive patients from 23 ICUs were reviewed for eligibility, resulting in 1359 patients and 3429 PIVCs being included in the analysis population. The median dwell time was 46.2 h (95% confidence interval [CI], 21.3-82.9). Phlebitis occurred in 9.1% (95% CI, 8.2-10.1%) of catheters (3.5 cases/100 catheter days). The multivariate analysis revealed that the only factors that increased the risk of developing phlebitis were drugs administered intravenously. This study included 26 drugs, and 4 were associated with increased phlebitis: nicardipine (HR, 1.85; 95% CI, 1.29-2.66), noradrenaline (HR, 2.42; 95% CI, 1.40-4.20), amiodarone (HR, 3.67; 95% CI, 1.75-7.71) and levetiracetam (HR, 5.65; 95% CI, 2.80-11.4). Alternatively, factors significantly associated with a reduced risk of phlebitis were: standardized drug administration measures in the ICU (HR, 0.35; 95% CI, 0.17-0.76), 30≤ BMI (HR, 0.43; 95% CI, 0.20-0.95), catheter inserted by a doctor as nurse reference (HR, 0.55; 95% CI, 0.32-0.94), and upper arm insertion site as forearm reference (HR, 0.52; 95% CI, 0.32-0.85). The nitroglycerin was associated with a reduced phlebitis risk (HR, 0.22; 95% CI, 0.05-0.92). CONCLUSION: Various factors are involved in the development of phlebitis caused by PIVCs in critically ill patients, including institutional, patient, catheter, and drug-induced factors, indicating the need for appropriate device selection or models of care in the ICU. TRIAL REGISTRATION: UMIN-CTR, the Japanese clinical trial registry (registration number: UMIN000028019, July 1, 2017).

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Nasal intubation for trauma patients and increased in-hospital mortality.

Yamamoto R, Fujishima S, Sasaki J

European journal of trauma and emergency surgery : official publication of the European Trauma Society （European Journal of Trauma and Emergency Surgery）  48 （ 4 ） 2795 - 2802 2022年01月

ISSN  1863-9933

　概要を見る

Purpose: Data regarding harm from nasal intubation in trauma patients have been conflicting. This study aims to elucidate whether nasal intubation is associated with increased in-hospital mortality compared with oral intubation. Methods: A retrospective cohort study on a nationwide trauma registry of 2004–2019 was conducted. Adult trauma patients who underwent nasal or oral intubation during initial resuscitation were selected. In-hospital mortality and lung complications were compared between nasal and oral intubations. A generalized estimating equation model accounting for within-institution clustering was adopted. Patient demographics, comorbidities, mechanism, injury severity, and vital signs on hospital arrival were adjusted. Subgroup analyses were conducted based on age, Abbreviated Injury Scale [AIS] for the head and face, and vital signs on arrival. Results: Among 29,271 patients eligible for the study, 667 were intubated nasally. In-hospital mortality was higher in nasal intubation compared with oral intubation (OR, 1.28 [95% CI, 1.01–1.64]). There were more noninfectious pulmonary complications in nasal intubation (OR, 1.48 [1.14–1.94]). The harms of nasal intubation were observed only in the elderly (age ≥ 75), patients with severe head injury (AIS in the head ≥ 4), and normotensive patients (systolic blood pressure ≥ 90 mmHg). Conversely, mortality was comparable regardless of the route of intubation in patients with complicated facial injury (AIS in the face ≥ 3). Conclusion: Nasal intubation was associated with increased in-hospital mortality, particularly in older patients and severe head injury, but not severe facial injury. The route of intubation should be judiciously decided during trauma resuscitation.

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Japanese rapid/living recommendations on drug management for COVID-19: updated guidelines (July 2022).

Yamakawa K, Yamamoto R, Terayama T, Hashimoto H, Ishihara T, Ishimaru G, Imura H, Okano H, Narita C, Mayumi T, Yasuda H, Yamada K, Yamada H, Kawasaki T, Shime N, Doi K, Egi M, Ogura H, Aihara M, Kushimoto S, Nishida O, Special Committee of the Japanese Clinical Practice Guidelines for the Management of Sepsis and Septic Shock 2020 (J‐SSCG 2020), the COVID‐19 Task Force

Acute medicine & surgery 9 （ 1 ） e789 2022年01月

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Development of On-Site Medical System for Mass-Gathering Events During TOKYO 2020: Vulnerability Analysis Using Healthcare Failure Mode and Effect Analysis.

Yamamoto R, Maeshima K, Asakawa S, Haiden A, Nishida Y, Yamazaki N, Homma K, Sasaki J

Disaster medicine and public health preparedness （Disaster Medicine and Public Health Preparedness）  17 （ 4 ） 1 - 7 2021年12月

共著,  ISSN  1935-7893

　概要を見る

At mass-gathering events of the Olympic and Paralympic Games, a well-organized, on-site medical system is essential. This study evaluated the vulnerabilities of the prehospital medical system of the TOKYO 2020 Olympic and Paralympic Games (TOKYO2020) to propose corrections that can be generalized to other mass gatherings. The healthcare failure mode and effect analysis (HFMEA) was adopted to analyze vulnerabilities of the on-site medical system proposed by the organizing committee of TOKYO2020. Processes from detecting a patient on the scene to completing transport to a hospital were analyzed. Ten processes with 47 sub-processes and 122 possible failure modes were identified. HFMEA revealed 9 failure modes as vulnerabilities: misidentification of patient, delayed immediate care at the scene, misjudgment of disposition from the on-site medical suite, and inappropriate care during transportation to hospital. Proposed corrections included surveillance to decrease blind spots, first aid brochures for spectators, and uniform protocol for health care providers at the scene. The on-site medical system amended by HFMEA seemed to work appropriately in TOKYO2020.

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Serum D-dimer level as a biomarker for identifying patients with isolated injury to prevent unnecessary whole-body computed tomography in blunt trauma care

Nakama R., Yamamoto R., Izawa Y., Tanimura K., Mato T.

Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine （Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine）  29 （ 1 ） 12 - 12 2021年12月

研究論文（学術雑誌）, 共著

　概要を見る

Background: Unnecessary whole-body computed tomography (CT) may lead to excess radiation exposure. Serum D-dimer levels have been reported to correlate with injury severity. We examined the predictive value of serum D-dimer level for identifying patients with isolated injury that can be diagnosed with selected-region CT rather than whole-body CT. Methods: This single-center retrospective cohort study included patients with blunt trauma (2014–2017). We included patients whose serum D-dimer levels were measured before they underwent whole-body CT. “Isolated” injury was defined as injury with Abbreviated Injury Scale (AIS) score ≤ 5 to any of five regions of interest or with AIS score ≤ 1 to other regions, as revealed by a CT scan. A receiver operating characteristic curve (ROC) was drawn for D-dimer levels corresponding to isolated injury; the area under the ROC (AUROC) was evaluated. Sensitivity, specificity, positive predictive value, and negative predictive value were calculated for several candidate cut-off values for serum D-dimer levels. Results: Isolated injury was detected in 212 patients. AUROC was 0.861 (95% confidence interval [CI]: 0.815–0.907) for isolated injury prediction. Serum D-dimer level ≤ 2.5 μg/mL was an optimal cutoff value for predicting isolated injury with high specificity (100.0%) and positive predictive value (100.0%). Approximately 30% of patients had serum D-dimer levels below this cutoff value. Conclusion: D-dimer level ≤ 2.5 μg/mL had high specificity and high positive predictive value in cases of isolated injury, which could be diagnosed with selected-region CT, reducing exposure to radiation associated with whole-body CT.

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Hyperoxemia during resuscitation of trauma patients and increased intensive care unit length of stay: inverse probability of treatment weighting analysis

Yamamoto R., Fujishima S., Sasaki J., Gando S., Saitoh D., Shiraishi A., Kushimoto S., Ogura H., Abe T., Mayumi T., Kotani J., Nakada T.a., Shiino Y., Tarui T., Okamoto K., Sakamoto Y., Shiraishi S.I., Takuma K., Tsuruta R., Masuno T., Takeyama N., Yamashita N., Ikeda H., Ueyama M., Hifumi T., Yamakawa K., Hagiwara A., Otomo Y.

World Journal of Emergency Surgery （World Journal of Emergency Surgery）  16 （ 1 ） 19 - 19 2021年12月

研究論文（学術雑誌）, 共著

　概要を見る

Background: Information on hyperoxemia among patients with trauma has been limited, other than traumatic brain injuries. This study aimed to elucidate whether hyperoxemia during resuscitation of patients with trauma was associated with unfavorable outcomes. Methods: A post hoc analysis of a prospective observational study was carried out at 39 tertiary hospitals in 2016–2018 in adult patients with trauma and injury severity score (ISS) of > 15. Hyperoxemia during resuscitation was defined as PaO2 of ≥ 300 mmHg on hospital arrival and/or 3 h after arrival. Intensive care unit (ICU)-free days were compared between patients with and without hyperoxemia. An inverse probability of treatment weighting (IPW) analysis was conducted to adjust patient characteristics including age, injury mechanism, comorbidities, vital signs on presentation, chest injury severity, and ISS. Analyses were stratified with intubation status at the emergency department (ED). The association between biomarkers and ICU length of stay were then analyzed with multivariate models. Results: Among 295 severely injured trauma patients registered, 240 were eligible for analysis. Patients in the hyperoxemia group (n = 58) had shorter ICU-free days than those in the non-hyperoxemia group [17 (10–21) vs 23 (16–26), p < 0.001]. IPW analysis revealed the association between hyperoxemia and prolonged ICU stay among patients not intubated at the ED [ICU-free days = 16 (12–22) vs 23 (19–26), p = 0.004], but not among those intubated at the ED [18 (9–20) vs 15 (8–23), p = 0.777]. In the hyperoxemia group, high inflammatory markers such as soluble RAGE and HMGB-1, as well as low lung-protective proteins such as surfactant protein D and Clara cell secretory protein, were associated with prolonged ICU stay. Conclusions: Hyperoxemia until 3 h after hospital arrival was associated with prolonged ICU stay among severely injured trauma patients not intubated at the ED. Trial registration: UMIN-CTR, UMIN000019588. Registered on November 15, 2015.

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Emergency angiography for trauma patients and potential association with acute kidney injury

Yamamoto R., Cestero R.F., Yoshizawa J., Maeshima K., Sasaki J.

World Journal of Emergency Surgery （World Journal of Emergency Surgery）  16 （ 1 ） 56 2021年12月

共著

　概要を見る

Background: Angiography has been conducted as a hemostatic procedure for trauma patients. While several complications, such as tissue necrosis after embolization, have been reported, little is known regarding subsequent acute kidney injury (AKI) due to contrast media. To elucidate whether emergency angiography would introduce kidney dysfunction in trauma victims, we compared the incidence of AKI between patients who underwent emergency angiography and those who did not. Methods: A retrospective cohort study was conducted using a nationwide trauma database (2004–2019), and adult trauma patients were included. The indication of emergency angiography was determined by both trauma surgeons and radiologists, and AKI was diagnosed by treating physicians based on a rise in serum creatinine and/or fall in urine output according to any published standard criteria. Incidence of AKI was compared between patients who underwent emergency angiography and those who did not. Propensity score matching was conducted to adjust baseline characteristics including age, comorbidities, mechanism of injury, vital signs on admission, Injury Severity Scale (ISS), degree of traumatic kidney injury, surgical procedures, and surgery on the kidney, such as nephrectomy and nephrorrhaphy. Results: Among 230,776 patients eligible for the study, 14,180 underwent emergency angiography. The abdomen/pelvis was major site for angiography (10,624 [83.5%]). Embolization was performed in 5,541 (43.5%). Propensity score matching selected 12,724 pairs of severely injured patients (median age, 59; median ISS, 25). While the incidence of AKI was rare, it was higher among patients who underwent emergency angiography than in those who did not (140 [1.1%] vs. 67 [0.5%]; odds ratio = 2.10 [1.57–2.82]; p < 0.01). The association between emergency angiography and subsequent AKI was observed regardless of vasopressor usage or injury severity in subgroup analyses. Conclusions: Emergency angiography in trauma patients was probably associated with increased incidence of AKI. The results should be validated in future studies.

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集中治療にて救命しえた腎移植後COVID-19の1例

森田 伸也, 高橋 遼平, 浅岡 雅人, 山元 良, 長田 大雅, 本間 康一郎, 川田 一郎, 吉田 理, 石井 誠, 浅沼 宏, 中川 健, 大家 基嗣

日本臨床腎移植学会雑誌 （(一社)日本臨床腎移植学会）  9 （ 2 ） 207 - 210 2021年12月

ISSN  2187-9907

　概要を見る

56歳男性。紫斑病性腎炎による慢性腎不全にてX-19年血液透析導入、同年血液型適合生体腎移植施行。維持免疫抑制剤はシクロスポリン(CyA)、ミコフェノール酸モフェチル(MMF)、プレドニゾロン(PSL)であった。X年に頭重感と微熱を主訴に来院、CTにて肺一部にすりガラス影を認め、鼻咽頭PCRにてSARS-CoV-2陽性となり緊急入院。MMF減量しファビピラビル、セフトリアキソン投与開始した。さらに抗生剤をタゾバクタム/ピペラシリンに、PSLをデキサメタゾンとしMMFを中止した。肺炎増悪したためメチルプレドニゾロン(mPSL)90mg/day投与、抗凝固療法開始しCyA減量した。呼吸状態増悪のため人工呼吸器管理としCyA中止、レムデシビル投与開始、腹臥位療法を施行した。一時血液透析を3回施行。徐々に酸素化は改善しmPSLは漸減とした。細菌性肺炎合併を疑い抗生剤をバンコマイシンとメロペネムとし、肺炎は改善した。下気道PCRにてSARS-CoV-2陰性を2回確認後CyA、MMFを再開し退院となった。(著者抄録)

複合的指標に基づく重症外傷患者選別基準とアンダートリアージの低下

矢島 慶太郎, 山元 良, 船曳 知弘, 北野 光秀, 佐々木 淳一

日本救急医学会雑誌 （(一社)日本救急医学会）  32 （ 11 ） 551 - 558 2021年11月

共著,  ISSN  0915-924X

　概要を見る

【目的】重症外傷の病院前選別ではアンダートリアージの減少が予後改善に寄与するとされているが,本邦では病院前の重症外傷選定基準に関する研究は少ない。そこで,受傷機転と生理学的・解剖学的所見による複合的基準が重症外傷のアンダートリアージ減少に関連しているか検証した。【対象】2016年10月からの2年間に横浜市指定4区で発生した外傷患者を対象に,後ろ向き観察研究を行った。現場から搬送され入院あるいは外来死亡した症例の中で,来院時心肺停止を除外し解析を行った。研究期間前半はショックを伴う頸胸腹損傷・両側大腿骨骨折を重症外傷と判定し(基準A),後半は高リスク受傷機転および生理学的・解剖学的異常所見を複合的に用いて判定した(基準B)。基準を満たさず搬送され重症外傷と診断された症例をアンダートリアージとし,各基準のアンダートリアージ率を比較した。【結果】539例の対象症例のうち,基準A運用期間は281例,基準B運用期間は258例であった。年齢や重症度は両期間とも相似していたが,緊急手術は基準B運用期間で多かった。アンダートリアージ率は,基準Aで27.6%,基準Bで18.1%であり,基準Bで有意に低かった(p=0.04)。【結語】外傷患者の搬送プロトコールにおいて,受傷機転,生理学的所見,および解剖学的所見を複合的に用いた重症患者選別基準がアンダートリアージの減少につながることが示唆された。(著者抄録)

来院時低血圧と造影CT後の造影剤腎症

吉澤 城, 山元 良, 本間 康一郎, 上倉 英恵, 関根 和彦, 小林 陽介, 船曳 知弘, 佐々木 淳一

日本救急医学会雑誌 （(一社)日本救急医学会）  32 （ 12 ） 1678 - 1678 2021年11月

ISSN  0915-924X

重症COVID-19における早期腹臥位療法の検討 多施設共同後方視的研究

丸山 修平, 山川 一馬, 山元 良, 遠藤 彰, 田上 隆, 金山 周史, 齊藤 福樹, 吉矢 和久, 中森 靖, 鍬方 安行, J-RECOVER study group

日本救急医学会雑誌 （(一社)日本救急医学会）  32 （ 12 ） 1485 - 1485 2021年11月

ISSN  0915-924X

Monitoring of gastric residual volume during enteral nutrition.

Yasuda H, Kondo N, Yamamoto R, Asami S, Abe T, Tsujimoto H, Tsujimoto Y, Kataoka Y

The Cochrane database of systematic reviews 9 （ 9 ） CD013335 2021年09月

ISSN  1361-6137

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Reply to Swinging the pendulum in prehospital trauma mortality needs a more holistic approach.

Yamamoto R, Suzuki M, Sasaki J

The journal of trauma and acute care surgery 91 （ 3 ） e81 - e82 2021年09月

共著,  ISSN  2163-0755

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COVID-19ガイドラインにおける各薬剤の推奨 CQ1(ファビピラビル)、CQ2(レムデシビル)、CQ3(ハイドロキシクロロキン)、CQ4-1(ステロイド)、CQ4-2(ステロイドパルス)

寺山 毅郎, 山川 一馬, 橋本 英樹, 井村 春樹, 山元 良, 石原 唯史, 石丸 剛, 岡野 弘, 成田 知大, 真弓 卓也, 安田 英人, 山田 浩平, 山田 博之, 川崎 達也, 志馬 伸朗, 土井 研人, 江木 盛時, 小倉 裕司, 相原 守夫, 田中 裕, 西田 修, 日本版敗血症診療ガイドライン2020特別委員会COVID-19対策タスクフォース

日本集中治療医学会雑誌 （(一社)日本集中治療医学会）  28 （ Suppl.2 ） 295 - 295 2021年09月

ISSN  1340-7988

国内および海外のCOVID-19ガイドラインの動向

井村 春樹, 山川 一馬, 橋本 英樹, 寺山 毅郎, 山元 良, 石原 唯史, 石丸 剛, 岡野 弘, 成田 知大, 真弓 卓也, 安田 英人, 山田 浩平, 山田 博之, 川崎 達也, 志馬 伸朗, 土井 研人, 江木 盛時, 小倉 裕司, 相原 守夫, 田中 裕, 西田 修, 日本版敗血症診療ガイドライン2020特別委員会COVID-19対策タスクフォース

日本集中治療医学会雑誌 （(一社)日本集中治療医学会）  28 （ Suppl.2 ） 295 - 295 2021年09月

ISSN  1340-7988

COVID-19ガイドライン作成の意義

山川 一馬, 橋本 英樹, 寺山 毅郎, 井村 春樹, 山元 良, 石原 唯史, 石丸 剛, 岡野 弘, 成田 知大, 真弓 卓也, 安田 英人, 山田 浩平, 山田 博之, 川崎 達也, 志馬 伸朗, 土井 研人, 江木 盛時, 小倉 裕司, 相原 守夫, 田中 裕, 西田 修, 日本版敗血症診療ガイドライン2020特別委員会COVID-19対策タスクフォース

日本集中治療医学会雑誌 （(一社)日本集中治療医学会）  28 （ Suppl.2 ） 295 - 295 2021年09月

ISSN  1340-7988

COVID-19ガイドラインにおける各薬剤の推奨 CQ5(トシリズマブ)、CQ6(シクレソニド)、CQ7(抗凝固療法)

橋本 英樹, 山川 一馬, 寺山 毅郎, 井村 春樹, 山元 良, 石原 唯史, 石丸 剛, 岡野 弘, 成田 知大, 真弓 卓也, 安田 英人, 山田 浩平, 山田 博之, 川崎 達也, 志馬 伸朗, 土井 研人, 江木 盛時, 小倉 裕司, 相原 守夫, 田中 裕, 西田 修, 日本版敗血症診療ガイドライン2020特別委員会COVID-19対策タスクフォース

日本集中治療医学会雑誌 （(一社)日本集中治療医学会）  28 （ Suppl.2 ） 296 - 296 2021年09月

ISSN  1340-7988

日本版敗血症ガイドライン2020;初期蘇生・ステロイドを知る 敗血症に対するステロイド療法のエビデンス

福田 龍将, 藤島 清太郎, 升田 好樹, 山元 良, 遠藤 功二, 竹下 淳, 富永 直樹, 河野 浩幸, 名原 功, 豊崎 光信, 豊田 幸樹年, 平野 洋平, J-SSCG2020特別委員会

日本集中治療医学会雑誌 （(一社)日本集中治療医学会）  28 （ Suppl.2 ） 226 - 226 2021年09月

ISSN  1340-7988

本邦初のMAGICappガイドライン MAGICppの活用方法について

山元 良, 山川 一馬, 橋本 英樹, 寺山 毅郎, 井村 春樹, 石原 唯史, 石丸 剛, 岡野 弘, 成田 知大, 真弓 卓也, 安田 英人, 山田 浩平, 山田 博之, 川崎 達也, 志馬 伸朗, 土井 研人, 江木 盛時, 小倉 裕司, 相原 守夫, 田中 裕, 西田 修, 日本版敗血症診療ガイドライン2020特別委員会COVID-19対策タスクフォース

日本集中治療医学会雑誌 （(一社)日本集中治療医学会）  28 （ Suppl.2 ） 296 - 296 2021年09月

ISSN  1340-7988

The Japanese Clinical Practice Guidelines for Management of Sepsis and Septic Shock 2020 (J-SSCG 2020).

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

Journal of intensive care 9 （ 1 ） 53 2021年08月

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Sparsity of burn centers and prolonged length of hospital stay: A nationwide study.

Yamamoto R, Sato Y, Sasaki J

Burns : journal of the International Society for Burn Injuries （Burns）  47 （ 7 ） 1478 - 1485 2021年08月

共著,  ISSN  0305-4179

　概要を見る

Introduction: The optimal distribution of burn centers remains unclear. We aimed to determine the appropriate number of burn centers per population (density) and examined a nationwide registry with the hypothesis that low-density burn centers would be associated with unfavorable outcomes. Patients and methods: A retrospective study was conducted using the Japanese Society of Burn Injury registry (2011–2021). Burn center density was defined as the number of burn centers per one million population in each prefecture, and centers were trisected on the basis of density. Hospital-free days until day 30 were compared between patients at high-, middle-, and low-density centers. Inverse probability weighting was conducted to adjust baseline characteristics, including age, burn mechanism, and burn severity. Results: We included 6764, 6209, and 2200 patients at high-, middle-, and low-density burn centers, respectively. After adjusting for patient demographics and burn severity, patients at high- and middle-density centers (≥0.4 centers per one million population) had longer hospital-free days compared with those at low-density centers (11 [0–23] vs 11 [0–23] vs 8 [0–22] days; p < 0.001). Conclusions: Low burn center density (<0.4 centers per one million population) was associated with longer hospital stay, whereas no higher limit was determined.

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Physician-staffed ambulance and increased in-hospital mortality of hypotensive trauma patients following prolonged prehospital stay: A nationwide study

Yamamoto R., Suzuki M., Yoshizawa J., Nishida Y., Junichi S.

Journal of Trauma and Acute Care Surgery （Journal of Trauma and Acute Care Surgery）  91 （ 2 ） 336 - 343 2021年08月

共著,  ISSN  21630755

　概要を見る

BACKGROUND The benefits of physician-staffed emergency medical services (EMS) for trauma patients remain unclear because of the conflicting results on survival. Some studies suggested potential delays in definitive hemostasis due to prolonged prehospital stay when physicians are dispatched to the scene. We examined hypotensive trauma patients who were transported by ambulance, with the hypothesis that physician-staffed ambulances would be associated with increased in-hospital mortality, compared with EMS personnel-staffed ambulances. METHODS A retrospective cohort study that included hypotensive trauma patients (systolic blood pressure ≤ 90 mm Hg at the scene) transported by ambulance was conducted using the Japan Trauma Data Bank (2004-2019). Physician-staffed ambulances are capable of resuscitative procedures, such as thoracotomy and surgical airway management, while EMS personnel-staffed ambulances could only provide advanced life support. In-hospital mortality and prehospital time until the hospital arrival were compared between patients who were classified based on the type of ambulance. Inverse probability weighting was conducted to adjust baseline characteristics including age, sex, comorbidities, mechanism of injury, vital signs at the scene, injury severity, and ambulance dispatch time. RESULTS Among 14,652 patients eligible for the study, 738 were transported by a physician-staffed ambulance. In-hospital mortality was higher in the physician-staffed ambulance than in the EMS personnel-staffed ambulance (201/699 [28.8%] vs. 2287/13,090 [17.5%]; odds ratio, 1.90 [1.61-2.26]; adjusted odds ratio, 1.22 [1.14-1.30]; p < 0.01), and the physician-staffed ambulance showed longer prehospital time (50 [36-66] vs. 37 [29-48] min, difference = 12 [11-12] min, p < 0.01). Such potential harm of the physician-staffed ambulance was only observed among patients who arrived at the hospital with persistent hypotension (systolic blood pressure < 90 mm Hg on hospital arrival) in subgroup analyses. CONCLUSION Physician-staffed ambulances were associated with prolonged prehospital stay and increased in-hospital mortality among hypotensive trauma patients compared with EMS personnel-staffed ambulance. LEVEL OF EVIDENCE Therapeutic, level IV.

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Characteristics of burn injury during COVID-19 pandemic in Tokyo: A descriptive study.

Yamamoto R, Sato Y, Matsumura K, Sasaki J

Burns open : an international open access journal for burn injuries （Burns Open）  5 （ 4 ） 40 - 45 2021年07月

共著

　概要を見る

Introduction: Coronavirus disease 2019 (COVID-19) has drastically changed everyday life worldwide. This study aimed to determine how COVID-19 affected the characteristics and outcomes of patients with severe burn injury by examining a city-wide burn database in Tokyo. Patients and methods: A descriptive study was conducted in 14 burn centers using the Tokyo Burn Unit Association registry from 1999 to 2020. The pandemic started in 2020, while the stay-at-home order lasted from April to May. The demographics, mechanisms, severity, and clinical outcomes were assessed before and during these two time periods. Results: In total, 7061 patients with burn injury were enrolled. During the pandemic, there were less patients during the pandemic than previous years, except for April–May; this decreased toward the end of 2020. There were also more scald/contact burns in the upper extremity, less intended and assault injuries, shorter length of hospital stay, and lower in-hospital mortality. During the stay-at-home order, there was increased incidence of flame burns, inhalation injuries, and in-hospital mortality, as well as higher total body surface area of full-thickness burns. Conclusions: This study described the characteristics of burns during the COVID-19 pandemic. The association between the stay-at-home order and severity of burns should be further examined.

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Japanese Rapid/Living recommendations on drug management for COVID-19.

Yamakawa K, Yamamoto R, Ishimaru G, Hashimoto H, Terayama T, Hara Y, Hasegawa D, Ishihara T, Imura H, Okano H, Narita C, Mayumi T, Yasuda H, Yamada K, Yamada H, Kawasaki T, Shime N, Doi K, Egi M, Ogura H, Aihara M, Tanaka H, Nishida O, Special Committee of the Japanese Clinical Practice Guidelines for the Management of Sepsis, Septic Shock 2020 (J‐SSCG 2020), the COVID‐19 Task Force.

Acute medicine & surgery 8 （ 1 ） e664 2021年05月

共著

　概要を見る

The coronavirus disease (COVID-19) has spread worldwide since early 2020, and there are still no signs of resolution. The Japanese Clinical Practice Guidelines for the Management of Sepsis and Septic Shock (J-SSCG) 2020 Special Committee created the Japanese rapid/living recommendations on drug management for COVID-19 using the experience of creating the J-SSCGs. The Grades of Recommendation, Assessment, Development, and Evaluation (GRADE) approach was used to determine the certainty of the evidence and strength of the recommendations. The first edition of this guideline was released on 9 September, 2020, and this document is the revised edition (version 3.1) (released 30 March, 2021). Clinical questions (CQs) were set for the following seven drugs: favipiravir (CQ1), remdesivir (CQ2), hydroxychloroquine (CQ3), corticosteroids (CQ4), tocilizumab (CQ5), ciclesonide (CQ6), and anticoagulants (CQ7). Favipiravir is recommended for patients with mild COVID-19 not requiring supplemental oxygen (GRADE 2C); remdesivir for moderate COVID-19 patients requiring supplemental oxygen/hospitalization (GRADE 2B). Hydroxychloroquine is not recommended for all COVID-19 patients (GRADE 1B). Corticosteroids are recommended for moderate COVID-19 patients requiring supplemental oxygen/hospitalization (GRADE 1B) and severe COVID-19 patients requiring ventilator management/intensive care (GRADE 1A); however, their use is not recommended for mild COVID-19 patients not requiring supplemental oxygen (GRADE 1B). Tocilizumab is recommended for moderate COVID-19 patients requiring supplemental oxygen/hospitalization (GRADE 2B). Anticoagulant therapy is recommended for moderate COVID-19 patients requiring supplemental oxygen/hospitalization and severe COVID-19 patients requiring ventilator management/intensive care (GRADE 2C). We hope that these clinical practice guidelines will aid medical professionals involved in the care of COVID-19 patients.

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高齢者大腿骨近位部骨折に対する積極的疼痛管理と術後せん妄についての検討

宇田川 和彦, 山元 良, 島谷 直孝, 西田 有正, 大野 聡一郎, 佐々木 淳一

骨折 （(一社)日本骨折治療学会）  43 （ 3 ） 820 - 823 2021年05月

共著,  ISSN  0287-2285

　概要を見る

【目的】高齢者の大腿骨近位部骨折に対する積極的疼痛管理と術後せん妄の発生頻度の関連を明らかにする.【方法】2017年1月〜2019年3月までに当院当科を受診した70歳以上の大腿骨近位部骨折症例のうち,当科で手術を施行した患者を対象とした.手術終了直後より鎮痛剤の持続投与を開始した群(Scheduled群)と,術後疼痛が出現した際に必要に応じて鎮痛剤を投与した群(As Needed群)に分け,両群間で術後せん妄およびその他の合併症の発生頻度を比較検討した.【結果】対象症例は75例,Scheduled群は27例であった.年齢,既往歴,骨折形態,手術待機時間,麻酔方法,手術方法,手術時間,その他術後せん妄に影響する因子は両群間において相似していた.術後せん妄は,Scheduled群がAs Needed群よりも有意に少なく(3例(11.0%) vs 17例(35.4%),p=0.03),合併症発症率は両群間で有意差を認めなかった.【結語】高齢者の大腿骨近位部骨折に対する術後積極的疼痛管理は術後せん妄の発生を予防できる可能性が示唆された.(著者抄録)

A case of abdominal compartment syndrome caused by amniotic fluid embolism treated with ABTHERA™ therapy: World's first report in the obstetric field

Hirata M., Hasegawa K., Kasuga Y., Haiden A., Ikenoue S., Yamamoto R., Tanaka M., Sasaki J., Ochiai D.

Taiwanese Journal of Obstetrics and Gynecology （Taiwanese Journal of Obstetrics and Gynecology）  60 （ 3 ） 579 - 580 2021年05月

研究論文（学術雑誌）, 共著,  ISSN  10284559

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COVID-19 shares clinical features with anti-melanoma differentiation-associated protein 5 positive dermatomyositis and adult Still’s disease

Kondo Y., Kaneko Y., Takei H., Tamai H., Kabata H., Suhara T., Yamamoto R., Nagata H., Ishii M., Sasaki J., Hasegawa N., Fukunaga K., Takeuchi T.

Clinical and Experimental Rheumatology （Clinical and Experimental Rheumatology）  39 （ 3 ） 631 - 638 2021年05月

共著,  ISSN  0392856X

　概要を見る

Objective To investigate the similarities and differences between Coronavirus disease 2019 (COVID-19) and autoimmune and autoinflammatory rheumatic diseases characterised by hyperferritinaemia, such as antimelanoma differentiation-associated protein 5 (MDA5) autoantibody-positive dermatomyositis and adult Still’s disease. Methods We reviewed consecutive, newly diagnosed, untreated patients with COVID-19, anti-MDA5 dermatomyositis, or adult Still’s disease. We compared their clinical, laboratory, and radiological characteristics, including the prevalence of macrophage activation syndrome and lung involvement in each disease. Results The numbers of patients with COVID-19, anti-MDA5 dermatomyositis, and adult-onset Still’s disease with hyperferritinaemia (serum ferritin ≥500ng/dL) who were included for main analysis were 22, 14, and 59, respectively. COVID-19 and adult Still’s disease both featured hyperinflammatory status, such as high fever and elevated serum C-reactive protein, whereas COVID-19 and anti-MDA5 dermatomyositis both presented with severe interstitial lung disease and hypoxaemia. While two-thirds of the patients in each group met the criteria for macrophage-activated syndrome that is used in systemic juvenile idiopathic arthritis, the HScore, an indicator of haemophagocytic lymphohistiocytosis, was low in anti-MDA5 dermatomyositis and COVID-19 even in severe or critical cases. The findings of chest computed tomography were similar between COVID-19 and anti-MDA5 dermatomyositis. Conclusion COVID-19 shared clinical features with rheumatic diseases characterised by hyperferritinaemia, including anti-MDA5 dermatomyositis and adult Still’s disease. These findings should be investigated further in order to shed light on the pathogenesis of not only COVID-19 but also the aforementioned rheumatic diseases.

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The real-time reverse transcription-polymerase chain reaction threshold cycle values for severe acute respiratory syndrome coronavirus 2 predict the prognosis of coronavirus disease 2019 pneumonia

Fukushima T., Kabata H., Yamamoto R., Suhara T., Uwamino Y., Kondo Y., Masaki K., Kamata H., Nagata H., Homma K., Kaneko Y., Ishii M., Sasaki J., Morisaki H., Hasegawa N., Fukunaga K.

Respiratory Investigation （Respiratory Investigation）  59 （ 3 ） 360 - 363 2021年05月

共著,  ISSN  22125345

　概要を見る

The clinical course of coronavirus disease 2019 (COVID-19) varies from mild to critical. We retrospectively examined whether clinical and laboratory findings on admission could predict COVID-19 prognosis. Among various factors associated with COVID-19 severity, our results indicated that the real-time reverse transcription-polymerase chain reaction (RT-PCR) threshold cycle (Ct) values for severe acute respiratory syndrome coronavirus 2 were the most useful predictor of COVID-19 prognosis.

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Accuracy for Mortality Prediction With Additive Biomarkers Including Interleukin-6 in Critically Ill Patients: A Multicenter Prospective Observational Study.

Yamamoto R, Sasaki J, Shibusawa T, Nakada TA, Mayumi T, Takasu O, Matsuda K, Shimazui T, Otsubo H, Teshima Y, Nabeta M, Moriguchi T, Oda S

Critical care explorations 3 （ 4 ） e0387 2021年04月

共著

　概要を見る

Objectives: Several inflammation markers have been reported to be associated with unfavorable clinical outcomes in critically ill patients. We aimed to elucidate whether serum interleukin-6 concentration considered with Sequential Organ Failure Assessment score can better predict mortality in critically ill patients. Design: A prospective observational study. Setting: Five university hospitals in 2016-2018. Patients: Critically ill adult patients who met greater than or equal to two systemic inflammatory response syndrome criteria at admission were included, and those who died or were discharged within 48 hours were excluded. Interventions: Inflammatory biomarkers including interleukin (interleukin)-6, -8, and -10; tumor necrosis factor-α; C-reactive protein; and procalcitonin were blindly measured daily for 3 days. Area under the receiver operating characteristic curve for Sequential Organ Failure Assessment score at day 2 according to 28-day mortality was calculated as baseline. Combination models of Sequential Organ Failure Assessment score and additional biomarkers were developed using logistic regression, and area under the receiver operating characteristic curve calculated in each model was compared with the baseline. Measurements and Main Results: Among 161 patients included in the study, 18 (11.2%) did not survive at day 28. Univariate analysis for each biomarker identified that the interleukin-6 (days 1-3), interleukin-8 (days 0-3), and interleukin-10 (days 1-3) were higher in nonsurvivors than in survivors. Analyses of 28-day mortality prediction by a single biomarker showed interleukin-6, -8, and -10 at days 1-3 had a significant discrimination power, and the interleukin-6 at day 3 had the highest area under the receiver operating characteristic curve (0.766 [0.656-0.876]). The baseline area under the receiver operating characteristic curve for Sequential Organ Failure Assessment score predicting 28-day mortality was 0.776 (0.672-0.880). The combination model using additional interleukin-6 at day 3 had higher area under the receiver operating characteristic curve than baseline (area under the receiver operating characteristic curve = 0.844, area under the receiver operating characteristic curve improvement = 0.068 [0.002-0.133]), whereas other biomarkers did not improve accuracy in predicting 28-day mortality. Conclusions: Accuracy for 28-day mortality prediction was improved by adding serum interleukin-6 concentration to Sequential Organ Failure Assessment score.

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Japanese rapid/living recommendations on drug management for COVID-19: updated guidelines (September 2021).

Yamakawa K, Yamamoto R, Terayama T, Hashimoto H, Ishihara T, Ishimaru G, Imura H, Okano H, Narita C, Mayumi T, Yasuda H, Yamada K, Yamada H, Kawasaki T, Shime N, Doi K, Egi M, Ogura H, Aihara M, Kushimoto S, Nishida O, Special Committee of the Japanese Clinical Practice Guidelines for the Management of Sepsis and Septic Shock 2020 (J‐SSCG 2020), the COVID‐19 Task Force.

Acute medicine & surgery 8 （ 1 ） e706 2021年01月

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The Japanese Clinical Practice Guidelines for Management of Sepsis and Septic Shock 2020 (J-SSCG 2020).

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

Acute medicine & surgery 8 （ 1 ） e659 2021年01月

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Perioperative clinical parameters associated with short-term mortality after colorectal perforation

Matsuoka T., Yamamoto R., Matsumura K., Kondo R., Kobayashi K., Lefor A.K., Sasaki J., Shinozaki H.

European Journal of Trauma and Emergency Surgery （European Journal of Trauma and Emergency Surgery）  48 （ 4 ） 3017 - 3024 2021年

共著,  ISSN  18639933

　概要を見る

Purpose: Although early prediction of mortality is useful for the management of patients with colorectal perforations, no significant perioperative predictive factors have been identified. The purpose of this study was to identify useful prognostic factors for patients with colorectal perforation. Methods: This single-center retrospective study included consecutive patients undergoing emergency surgery for colorectal perforation from January 2012 to December 2019. The primary outcome was combined 30 day and in-hospital mortality. Patient- and disease-related factors obtained perioperatively were evaluated for mortality prediction. A scoring system was developed to enhance clinical utility. Results: Overall, 146 patients were included and 20 (14%) died after surgery. Multivariate logistic regression identified five predictive factors: age, hemodialysis, uncommon perforation etiology, plasma albumin level, and decreased platelet count. The area under the receiver operating curve for the scoring system using these parameters was 0.894 (95% CI 0.835–0.952). Patients at high-risk of mortality were classified by the proposed score with a sensitivity of 90.0% and negative predictive value of 98.0%. Conclusion: This study identified five perioperative factors significantly associated with mortality of patients with colorectal perforation. Although these parameters predict mortality of patients with colorectal perforation using a score with high discrimination, further study is required to confirm these findings.

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水素ガス吸入療法の現状と将来性

山元 良, 本間 康一郎, 佐野 元昭, 佐々木 淳一

ファルマシア （公益社団法人 日本薬学会）  57 （ 1 ） 44 - 47 2021年

共著,  ISSN  0014-8601

　概要を見る

水素ガス吸入療法に関する様々な動物および臨床研究が行われており、種々の疾患・病態に対して治療効果を持つことが示唆され、人に対しての安全性が示されている。特に、急性心筋梗塞や心肺停止蘇生後症候群、さらには新型コロナウイルス感染症においての治療研究が進んでおり、心肺停止蘇生後症候群に関しては、二重盲検下ランダム化比較試験が複数の医療機関において現在進行中である。ここでは、水素ガスの将来の新規薬剤としての可能性を紹介する。

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Clinical parameters and optimal candidates for early definitive fixation of extremity injury: A nationwide study

Yamamoto R., Udagawa K., Yusho Nishida , Soichiro Ono , Junichi Sasaki

Journal of Orthopaedic Science （Journal of Orthopaedic Science）  28 （ 1 ） 255 - 260 2021年

共著,  ISSN  09492658

　概要を見る

Background: While various strategies of fracture fixation for trauma patients have been discussed, optimal candidates remain unclear for early definitive fixation. The aim of this study was to integrate several clinical parameters into a scoring system and determine a cut-off value for safe early definitive surgery for extremity fractures. Methods: We retrospectively identified patients with fracture in an extremity in Japanese Trauma Data Bank from 2004 to 2019. We included adult patients who underwent open reduction and internal fixation for extremity injury before any other surgical intervention and excluded those who arrived with cardiac arrest. Several clinical parameters, such as age, vital signs, abbreviated injury scale (AIS) in the chest, and injury severity score (ISS), were examined with multivariate logistic regression models to predict in-hospital mortality, and then integrated into a scoring system based on each odds ratio. To determine a cut-off value of the scoring system for safe early definitive surgery, in-hospital mortality and/or postoperative complications were compared between patients who underwent definitive fixation within 24 h of injury and patients who did not in subgroups based on the scores. Results: Of 50,631 patients eligible for this study, 16,119 (31.8%) underwent early definitive fixation. A 0–15 scoring system with parameters including age >70 years, GCS <8, systolic blood pressure <90 mmHg, AIS in the chest ≥3, ISS ≥20, and transfusion requirement within 24 h of arrival was developed. At scores ≥10, early definitive fixation was found to be significantly associated with high in-hospital mortality, and at scores <10, in-hospital mortality was comparable between the two groups. Conclusions: We integrated clinical parameters into the scoring system with a scale of 0–15 and determined that a score of 10 is the cut-off score. We determined that patients with a score <10 can safely undergo early definitive fixation.

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十二指腸後腹膜穿通が疑われ非手術的加療を行った十二指腸水平脚憩室症の1例

栗原 智宏, 西田 有正, 増澤 佑哉, 前島 克哉, 山元 良, 佐藤 幸男, 佐々木 淳一

日本救急医学会雑誌 （(一社)日本救急医学会）  31 （ 12 ） 2444 - 2448 2020年12月

共著,  ISSN  0915-924X

　概要を見る

十二指腸憩室症自体は結腸憩室に次ぐ頻度で珍しい疾患ではないとされているが、報告例の多くが下行脚または傍乳頭憩室であり、水平脚の報告は限定される。いずれの部位でも無症状で特別な治療を要することは少なく経過観察されることが多いが、有症状時には部位によって鑑別に苦慮することがある。十二指腸後腹膜穿通と誤認した十二指腸水平脚憩室症の1例を経験したため、文献的考察を加えて報告する。症例は50歳代の女性。突然発症した腹痛を主訴に前医に救急搬送され十二指腸後腹膜穿通の診断にて入院となった。しかし、緊急手術となった際に対応が不能とのことで翌日に当院へ転院となった。来院後、消化性潰瘍による十二指腸後腹膜穿通と診断したが、病変は限局していたため非手術的に加療を開始した。臨床経過は順調に経過したが、2週間経過しても消化管造影にて十二指腸壁外への造影剤漏出と考えられる所見が消失せず、十二指腸後腹膜穿通ではない可能性を強く疑った。以前に画像検査を施行した医療機関にCTデータの送付を依頼し確認したところ、その時から十二指腸後面に見える部分にガス像を認めており、十二指腸憩室症と診断できた。十二指腸水平脚部の憩室は比較的稀であるが、有症状時には後腹膜穿通と鑑別が困難で、侵襲的処置が選択されてしまう可能性があり注意を要する。(著者抄録)

日本版敗血症診療ガイドライン2020:Now Open! 敗血症に対するステロイド療法

藤島 清太郎, 遠藤 功二, 山元 良, 福田 龍将, 升田 好樹, 日本版敗血症診療ガイドライン2020特別委員会

日本救急医学会雑誌 （(一社)日本救急医学会）  31 （ 11 ） 911 - 911 2020年11月

ISSN  0915-924X

Hydrogen Gas Inhalation Attenuates Endothelial Glycocalyx Damage and Stabilizes Hemodynamics in a Rat Hemorrhagic Shock Model.

Tamura T, Sano M, Matsuoka T, Yoshizawa J, Yamamoto R, Katsumata Y, Endo J, Homma K, Kajimura M, Suzuki M, Kobayashi E, Sasaki J

Shock (Augusta, Ga.) （Shock (Augusta, Ga.)）  54 （ 3 ） 377 - 385 2020年09月

共著,  ISSN  1073-2322

　概要を見る

BACKGROUND: Hydrogen gas (H2) inhalation during hemorrhage stabilizes post-resuscitation hemodynamics, improving short-term survival in a rat hemorrhagic shock and resuscitation (HS/R) model. However, the underlying molecular mechanism of H2 in HS/R is unclear. Endothelial glycocalyx (EG) damage causes hemodynamic failure associated with HS/R. In this study, we tested the hypothesis that H2 alleviates oxidative stress by suppressing xanthine oxidoreductase (XOR) and/or preventing tumor necrosis factor-alfa (TNF-α)-mediated syndecan-1 shedding during EG damage. METHODS: HS/R was induced in rats by reducing mean arterial pressure (MAP) to 35 mm Hg for 60 min followed by resuscitation. Rats inhaled oxygen or H2 + oxygen after achieving shock either in the presence or absence of an XOR inhibitor (XOR-I) for both the groups. In a second test, rats received oxygen alone or antitumor necrosis factor (TNF)-α monoclonal antibody with oxygen or H2. Two hours after resuscitation, XOR activity, purine metabolites, cytokines, syndecan-1 were measured and survival rates were assessed 6 h after resuscitation. RESULTS: H2 and XOR-I both suppressed MAP reduction and improved survival rates. H2 did not affect XOR activity and the therapeutic effects of XOR-I and H2 were additive. H2 suppressed plasma TNF-α and syndecan-1 expression; however, no additional H2 therapeutic effect was observed in the presence of anti-TNF-α monoclonal antibody. CONCLUSIONS: H2 inhalation after shock stabilized hemodynamics and improved survival rates in an HS/R model independent of XOR. The therapeutic action of H2 was partially mediated by inhibition of TNF-α-dependent syndecan-1 shedding.

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日本版敗血症診療ガイドライン2020;初期蘇生・ステロイドを知る 敗血症に対する副腎皮質ステロイド投与 J-SSCG2020推奨の解説

藤島 清太郎, 遠藤 功二, 山元 良, 福田 龍将, 升田 好樹, 竹下 淳, 富永 直樹, 河野 浩幸, 名原 功, 豊崎 光信, 豊田 幸樹年, 平野 洋平, 安宅 一晃, 井上 茂亮, 射場 敏明, 垣花 泰之, 川崎 達也, 久志本 成樹, 黒田 泰弘, 小谷 穣治, 志馬 伸朗, 谷口 巧, 鶴田 良介, 土井 研人, 土井 松幸, 中田 孝明, 中根 正樹, 細川 直登, 松嶋 麻子, 松田 直之, 矢田部 智昭, 江木 盛時, 小倉 裕司, 田中 裕, 西田 修, J-SSCG2020特別委員会

日本集中治療医学会雑誌 （(一社)日本集中治療医学会）  27 （ Suppl. ） 259 - 259 2020年09月

ISSN  1340-7988

Oxygen administration in patients recovering from cardiac arrest: A narrative review

Yamamoto R., Yoshizawa J.

Journal of Intensive Care （Journal of Intensive Care）  8 （ 1 ） 60 2020年08月

共著

　概要を見る

© 2020 The Author(s). High oxygen tension in blood and/or tissue affects clinical outcomes in several diseases. Thus, the optimal target PaO2 for patients recovering from cardiac arrest (CA) has been extensively examined. Many patients develop hypoxic brain injury after the return of spontaneous circulation (ROSC); this supports the need for oxygen administration in patients after CA. Insufficient oxygen delivery due to decreased blood flow to cerebral tissue during CA results in hypoxic brain injury. By contrast, hyperoxia may increase dissolved oxygen in the blood and, subsequently, generate reactive oxygen species that are harmful to neuronal cells. This secondary brain injury is particularly concerning. Although several clinical studies demonstrated that hyperoxia during post-CA care was associated with poor neurological outcomes, considerable debate is ongoing because of inconsistent results. Potential reasons for the conflicting results include differences in the definition of hyperoxia, the timing of exposure to hyperoxia, and PaO2 values used in analyses. Despite the conflicts, exposure to PaO2 > 300 mmHg through administration of unnecessary oxygen should be avoided because no obvious benefit has been demonstrated. The feasibility of titrating oxygen administration by targeting SpO2 at approximately 94% in patients recovering from CA has been demonstrated in pilot randomized controlled trials (RCTs). Such protocols should be further examined.

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Resuscitative endovascular balloon occlusion of the aorta and traumatic out-of-hospital cardiac arrest: A nationwide study.

Yamamoto R, Suzuki M, Funabiki T, Nishida Y, Maeshima K, Sasaki J

Journal of the American College of Emergency Physicians open 1 （ 4 ） 624 - 632 2020年08月

共著

　概要を見る

Objective: Resuscitative endovascular balloon occlusion of the aorta (REBOA) is a less-invasive method for temporary hemostasis compared with cross-clamping the aorta through resuscitative thoracotomy (RT). Although the survival benefits of REBOA remained unclear, pathophysiological benefits were identified in patients with traumatic out-of-hospital cardiac arrest (t-OHCA). We examined the clinical outcomes of t-OHCA with the hypothesis that REBOA would be associated with higher survival to discharge compared with RT. Methods: A retrospective cohort study was conducted using the Japan Trauma Data Bank (2004-2019). Adult patients with t-OHCA who had arrived without a palpable pulse and undergone aortic occlusion were included. Patients were divided into REBOA or RT groups, and propensity scores were developed using age, mechanism of injury, presence of signs of life, presence of severe head and/or chest injury, Injury Severity Score, and transportation time. Inverse probability weighting by propensity scores was performed to compare survival to discharge between the 2 groups. Results: Among 13,247 patients with t-OHCA, 1483 were included in this study. A total of 144 (9.7%) patients were treated with REBOA, and 5 of 144 (3.5%) in the REBOA group and 10 of 1339 (0.7%) in the RT group survived to discharge. The use of REBOA was significantly associated with increased survival to discharge (odds ratio, 4.78; 95% confidence interval, 1.61-14.19), which was confirmed by inverse probability weighting (adjusted odds ratio, 3.73; 95% confidence interval, 1.90-7.32). Conclusions: REBOA for t-OHCA was associated with higher survival to discharge. These results should be validated by further research.

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Hydrocortisone with fludrocortisone for septic shock: a systematic review and meta-analysis.

Yamamoto R, Nahara I, Toyosaki M, Fukuda T, Masuda Y, Fujishima S

Acute medicine & surgery （Wiley）  7 （ 1 ） e563 2020年01月

研究論文（学術雑誌）, 共著,  ISSN  2052-8817

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A novel scale for predicting delayed intubation in patients with inhalation injury

Matsumura K., Yamamoto R., Kamagata T., Kurihara T., Sekine K., Takuma K., Kase K., Sasaki J.

Burns （Burns）  46 （ 5 ） 1201 - 1207 2020年

研究論文（学術雑誌）, 共著, 査読有り,  ISSN  03054179

　概要を見る

© 2020 Elsevier Ltd and ISBI Background: Strategies to predict delayed airway obstruction in patients with inhalation injury have not been extensively studied. This study aimed to develop a novel scale, predicting the need for Delayed Intubation after inhalation injury (PDI) score. Methods: We retrospectively identified patients with inhalation injury at four tertiary care centers in Japan between 2012 and 2018. We included patients aged 15 or older and excluded those intubated within 30 min after hospital arrival. Predictors for delayed intubation were identified with univariate analyses and scored on the basis of odds ratios. The PDI score was evaluated with the area under the receiver operating characteristic (AUROC) curve and compared with other scaling systems for burn injuries. Results: Data from 158 patients were analyzed; of these patients, 18 (11.4%) were intubated during the delayed phase. Signs of respiratory distress, facial burn, and pharyngolaryngeal swelling observed on laryngoscopy, were identified as predictors for delayed intubation. The discriminatory power of the PDI (AUROC curve = 0.90; 95% confidence interval, 0.83 to 0.97; p < 0.01) was higher than that of the other scaling systems. Conclusions: We developed a novel scale for predicting delayed intubation in inhalation injury. The score should be further validated with other population.

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Length of hospital stay and mortality associated with burns from assault: a retrospective study with inverse probability weighting analysis.

Yamamoto R, Toyosaki M, Kurihara T, Sasaki J

Burns & trauma 8   tkaa001 2020年

研究論文（学術雑誌）, 共著, 査読有り,  ISSN  2321-3868

　概要を見る

Background: Burns resulting from assaults account for considerable morbidity and mortality among patients with burn injuries around the world. However, it is still unclear whether unfavorable clinical outcomes are associated primarily with the severity of the injuries. To elucidate the direct relationship between burns resulting from assaults and mortality and/or length of hospital stays, we performed this study with the hypothesis that burns from assault would be independently associated with fewer hospital-free days than would burns from other causes, regardless of the severity of burn injuries. Methods: We conducted a retrospective cohort study, using a city-wide burn registry (1996-2017) accounting for 14 burn centers in Tokyo, Japan. Patients who arrived within 24 hours after injury were included, and those with self-inflicted burn injuries were excluded. Patients were divided into two groups according to mechanism of burns (assault vs. accident), and the number of hospital-free days until day 30 after injury (a composite of in-hospital death and hospital length of stay) was compared between the groups. To estimate the probability that an injury would be classified as an assault, we calculated propensity scores, using multivariate logistic regression analyses adjusted for known outcome predictors. We also performed an inverse probability weighting (IPW) analysis to compare adjusted numbers of hospital-free days. Results: Of 7419 patients in the registry with burn injuries during the study period, 5119 patients were included in this study. Of these, 113 (2.2%) were injured as a result of assault; they had significantly fewer hospital-free days than did those with burns caused by accident (18 [27] vs. 24 [20] days; coefficient = [Formula: see text]3.4 [[Formula: see text]5.5 to [Formula: see text]1.3] days; p = 0.001). IPW analyses similarly revealed the independent association between assault burn injury and fewer hospital-free days (adjusted coefficient = [Formula: see text]0.6 [[Formula: see text]1.0 to [Formula: see text]0.1] days; p = 0.009). Conclusions: Burn from assault was independently associated with fewer hospital-free days, regardless of the severity of burn injuries. The pathophysiological mechanism underlying the relationship should be further studied in a prospective observational study.

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Modified abbreviated burn severity index as a predictor of in-hospital mortality in patients with inhalation injury: development and validation using independent cohorts

Yamamoto R., Shibusawa T., Aikawa N., Sasaki J.

Surgery Today （Surgery Today）  51 （ 2 ） 242 - 249 2020年

共著,  ISSN  09411291

　概要を見る

© 2020, Springer Nature Singapore Pte Ltd. Purpose: The ability to accurately evaluate the severity of inhalation injury can help to optimize patient care. However, there is no accepted severity grading system, especially for inhalation injury. Methods: We screened a multicenter burn registry and included adult patients who required oxygen treatment or mechanical ventilation. After the patient data were divided into development and validation cohorts, missing values were replaced with multiple imputation. Twelve potential predictors were analyzed using multivariate logistic regression to identify prognostic variables for in-hospital mortality and scores were assigned to each predictor based on odds ratios to develop the Modified Abbreviated Burn Severity Index, mABSI. The mABSI was validated using c-statistics and calibration curves. Results: We randomly assigned 1377 and 919 patients to the development and validation cohorts, respectively. Age, self-inflicted injury, cutaneous burn area, and mechanical ventilation requirement were identified as independent predictors, and the mABSI (1–17 scale) was, thus, developed. The mABSI has a high discriminatory power (c-statistic = 0.94; 95% CI 0.92–0.97), and both estimated and observed in-hospital mortalities increased from 1% at score ≤ 5 to almost 100% at score ≥ 14 with linear calibration plots. Conclusions: We developed and validated the mABSI which accurately predicts in-hospital mortality.

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Hospital Preparedness for COVID-19: The Known and The Known Unknown

Kaito Daiki, Matsumura Kazuki, Yamamoto Ryo

Ｔｈｅ　Ｋｅｉｏ　Ｊｏｕｒｎａｌ　ｏｆ　Ｍｅｄｉｃｉｎｅ （The Keio Journal of Medicine）  70 （ 2 ） 25 - 34 2020年

共著,  ISSN  0022-9717

　概要を見る

<p>In late March 2020, we faced a nosocomial outbreak of novel coronavirus disease 2019 (COVID-19) at Keio University Hospital, Tokyo, Japan. Presently, COVID-19 is an unprecedented worldwide biohazard, and a nosocomial outbreak can occur in any hospital at any time. Therefore, we reviewed the literature regarding hospital preparedness, the initial management of COVID-19, and the surveillance of healthcare workers (HCWs) to find information that would be generally useful for physicians when confronted with COVID-19. In terms of hospital preparedness, each hospital should develop an incident management system and establish a designated multidisciplinary medical team. To initiate case management, COVID-19 should be suspected based on patient symptoms and/or high-risk history and then should be confirmed by viral testing, such as reverse transcription polymerase chain reaction (RT-PCR) analysis. Although some patients will become critically ill, the guidelines for respiratory failure and septic shock for non-COVID-19 cases can be followed for supportive treatment. Antiviral medications should be carefully selected because the available information is confused by the large volume of preprint literature and unreliable data. HCWs who have come into contact with patients with COVID-19 can generate new in-hospital clusters of COVID-19 cases. Quarantine following contact tracking with risk stratification is effective in preventing transmission, and the essentials of medical surveillance include monitoring different types of symptoms, delegation of supervision, and continuation of surveillance regardless of the RT-PCR results. Preparation for COVID-19 is recommended before the first COVID-19 case is encountered.</p>

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Delays in Surgical Intervention and Temporary Hemostasis Using Resuscitative Endovascular Balloon Occlusion of the aorta (REBOA): Influence of Time to Operating Room on Mortality

Yamamoto R., Cestero R.F., Muir M.T., Jenkins D.H., Eastridge B.J., Funabiki T., Sasaki J.

American Journal of Surgery （American Journal of Surgery）  220 （ 6 ） 1485 - 1491 2020年

共著,  ISSN  00029610

　概要を見る

© 2020 Elsevier Inc. Background: The optimal candidates for resuscitative endovascular balloon occlusion of the aorta (REBOA) remain unclear. We hypothesized that patients who experience delays in surgical intervention would benefit from REBOA. Methods: Using the Japan Trauma Databank (2014–2019), patients transferred to the operating room (OR) within 3 h were identified. Patients treated with REBOA were matched with those without REBOA using propensity scores, and further divided based on the transfer time to OR: ≤ 1 h (early), 1–2 h (delayed), and >2 h (significantly-delayed). Survival to discharge was compared. Results: Among 5258 patients, 310 underwent REBOA. In 223 matched pairs, patients treated with REBOA had improved survival (56.5% vs. 31.8%; p < 0.01), although in-hospital mortality was reduced by REBOA only in the delayed and significantly-delayed subgroups (HR = 0.43 [0.28–0.65] and 0.42 [0.25–0.71]). Conclusions: REBOA-treated trauma patients who experience delays in surgical intervention (>1 h) have improved survival.

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Hydrogen gas distribution in organs after inhalation: Real-time monitoring of tissue hydrogen concentration in rat

Yamamoto R., Homma K., Suzuki S., Sano M., Sasaki J.

Scientific Reports （Scientific Reports）  9 （ 1 ） 1255 - 1255 2019年12月

研究論文（学術雑誌）, 共著

　概要を見る

© 2019, The Author(s). Hydrogen has therapeutic and preventive effects against various diseases. Although animal and clinical studies have reported promising results, hydrogen distribution in organs after administration remains unclear. Herein, the sequential changes in hydrogen concentration in tissues over time were monitored using a highly sensitive glass microsensor and continuous inhalation of 3% hydrogen gas. The hydrogen concentration was measured in the brain, liver, kidney, mesentery fat and thigh muscle of rats. The maximum concentration, time to saturation, and other measurements representing the dynamics of distribution were obtained from the concentration curves, and the results obtained for different organs were compared. The time to saturation was significantly longer (20.2 vs 6.3–9.4 min. P = 0.004 in all cases) and increased more gradually in muscle than in the other organs. The maximum concentration was the highest in liver and the lowest in the kidney (29.0 ± 2.6 vs 18.0 ± 2.2 μmol/L; P = 0.03 in all cases). The concentration varied significantly depending on the organ (P = 0.03). These results provide the fundamentals for elucidating the mechanisms underlying the in vivo favourable effects of hydrogen gas in mammalian systems.

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Epinephrine during resuscitation of traumatic cardiac arrest and increased mortality: A post hoc analysis of prospective observational study

Yamamoto R., Suzuki M., Hayashida K., Yoshizawa J., Sakurai A., Kitamura N., Tagami T., Nakada T., Takeda M., Sasaki J.

Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine （Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine）  27 （ 1 ） 74 - 74 2019年08月

研究論文（学術雑誌）, 共著

　概要を見る

© 2019 The Author(s). Background: The beneficial effect of epinephrine during resuscitation from out-of-hospital cardiac arrest (OHCA) has been inconclusive, and potential harm has been suggested, particularly in trauma victims. Although no significant improvement in neurological outcomes has been found among resuscitated patients using epinephrine, including trauma patients, the use of epinephrine is recommended in the Advanced Trauma Life Support protocol. Given that the use of vasopressors was reported to be associated with increased mortality in patients with massive bleeding, the undesirable effects of epinephrine during the resuscitation of traumatic OHCA should be elucidated. We hypothesised that resuscitation with epinephrine would increase mortality in patients with OHCA following trauma. Methods: This study is a post-hoc analysis of a prospective, multicentre, observational study on patients with OHCA between January 2012 and March 2013. We included adult patients with traumatic OHCA who were aged ≥15 years and excluded those with missing survival data. Patient data were divided into epinephrine or no-epinephrine groups based on the use of epinephrine during resuscitation at the hospital. Propensity scores were developed to estimate the probability of being assigned to the epinephrine group using multivariate logistic regression analyses adjusted for known survival predictors. The primary outcome was survival 7 days after injury, which was compared among the two groups after propensity score matching. Results: Of the 1125 adults with traumatic OHCA during the study period, 1030 patients were included in this study. Among them, 822 (79.8%) were resuscitated using epinephrine, and 1.1% (9/822) in the epinephrine group and 5.3% (11/208) in the no-epinephrine group survived 7 days after injury. The use of epinephrine was significantly associated with decreased 7-day survival (odds ratio = 0.20; 95% CI = 0.08-0.48; P < 0.01), and this result was confirmed by propensity score-matching analysis, in which 178 matched pairs were examined (adjusted odds ratio = 0.11; 95% CI = 0.01-0.85; P = 0.02). Conclusions: The relationship between the use of epinephrine during resuscitation and decreased 7-day survival was found in patients with OHCA following trauma, and the propensity score-matched analyses validated the results. Resuscitation without epinephrine in traumatic OHCA should be further studied in a randomised controlled trial.

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Impact of cardiopulmonary resuscitation time on the effectiveness of emergency department thoracotomy after blunt trauma

Yamamoto R., Suzuki M., Nakama R., Kase K., Sekine K., Kurihara T., Sasaki J.

European Journal of Trauma and Emergency Surgery （European Journal of Trauma and Emergency Surgery）  45 （ 4 ） 697 - 704 2019年08月

共著,  ISSN  18639933

　概要を見る

© 2018, Springer-Verlag GmbH Germany, part of Springer Nature. Purpose: Debate remains about the threshold cardiopulmonary resuscitation (CPR) duration associated with futile emergency department thoracotomy (EDT). To validate the CPR duration associated with favorable outcomes, we investigated the relationship between CPR duration and return of spontaneous circulation (ROSC) after EDT in blunt trauma. Methods: A retrospective observational study was conducted at three tertiary centers over the last 7 years. We included bluntly injured adults who were pulseless and required EDT at presentation, but excluded those with devastating head injuries. After multivariate logistic regression identified the CRP duration as an independent predictor of ROSC, receiver operating characteristic curves were used to determine the threshold CPR duration. Patient data were divided into short- and long-duration CPR groups based on this threshold, and we developed a propensity score to estimate assignment to the short-duration CPR group. The ROSC rates were compared between groups after matching. Results: Forty patients were eligible for this study and ROSC was obtained in 12. The CPR duration was independently associated with the achievement of ROSC [odds ratio 1.18; 95% confidence interval (CI) 1.01–1.37, P = 0.04], and the threshold CPR duration was 17 min. Among the 14 patients with a short CPR duration, 13 matched with the patients with a long CPR duration, and a short CPR duration was significantly associated with higher rates of ROSC (odds ratio 8.80; 95% CI 1.35–57.43, P = 0.02). Conclusions: A CPR duration < 17 min is independently associated with higher ROSC rates in patients suffering blunt trauma.

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Self-inflicted burn injury is independently associated with increased mortality in a more economically developed country: A propensity score matching analysis

Yamamoto R., Shibusawa T., Kurihara T., Sasaki J.

Journal of Burn Care and Research （Journal of Burn Care and Research）  40 （ 2 ） 228 - 234 2019年02月

共著,  ISSN  1559047X

　概要を見る

© American Burn Association 2019. All rights reserved. Self-inflicted burn accounts for considerable morbidity and mortality in more economically developed countries, and there is a substantial debate regarding the pathophysiological relevance between self-inflicted burns and unfavorable outcomes. To validate whether self-inflicted injury is an independent predictor of high mortality regardless of the severity of burn, they conducted a retrospective observational study using the Japan Trauma Data Bank, a nationwide database including over 200 major tertiary care centers. Among 2006 patients with burn who had arrived at collaborating centers between 2004 and 2016, they included patients aged ≥15 years, those who did not present with cardiopulmonary arrest upon arrival, and those who had ≥10 percent total body surface area burns. Patients with missing survival data or unknown mechanism of injury were excluded. In total, 1094 patients were eligible, of whom 222 (20.3 percent) had self-inflicted burns. The patients were divided into the self-inflicted and non-self-inflicted groups, and propensity score was calculated using the demographic information of the patients, injury variables, time from injury to hospital arrival, and other survival predictors. Via a propensity score matching, 98 pairs were selected, and the self-inflicted group had a higher mortality than the non-self-inflicted group (43.9 vs 28.6 percent, hazard ratio = 1.77; 95% confidence interval = 1.10-2.86; P =.02). Inverse probability weighting and multivariate logistic regression were performed as sensitivity analyses, and results validated that self-inflicted burn was independently associated with increased in-hospital mortality. Therefore, patients with self-inflicted burns should receive judicious management, regardless of burn injury severity.

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A novel scoring system to predict the requirement for surgical intervention in victims of motor vehicle crashes: Development and validation using independent cohorts

Yamamoto R., Kurihara T., Sasaki J.

PLoS ONE （PLoS ONE）  14 （ 12 ） e0226282 2019年

研究論文（学術雑誌）, 共著

　概要を見る

© 2019 Yamamoto et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Background Given that there are still considerable number of facilities which lack surgical specialists round the clock across the world, the ability to estimate the requirement for emergency surgery in victims of motor vehicle crashes (MVCs) can ensure appropriate resource allocation. In this study, a surgical intervention in victims of MVC (SIM) score was developed and validated, using independent patient cohorts. Methods We retrospectively identified MVC victims in a nationwide trauma registry (2004–2016). Adults ≥ 15 years who presented with palpable pulse were included. Patients with missing data on the type/date of surgery were excluded. Patient were allocated to development or validation cohorts based on the date of injury. After missing values were imputed, predictors of the need for emergency thoracotomy and/or laparotomy were identified with multivariate logistic regression, and scores were then assigned using odds ratios. The SIM score was validated with area under the receiver operating characteristic curve (AUROC) and calibration plots of SIM score-derived probability and observed rates of emergency surgery. Results We assigned 13,328 and 12,348 patients to the development and validation cohorts, respectively. Age, motor vehicle collision and vital signs on hospital arrival were identified as independent predictors for emergency thoracotomy and/or laparotomy, and SIM score was developed as 0–9 scales. The score has a good discriminatory power (AUROC = 0.79; 95% confidence interval = 0.77–0.81), and both estimated and observed rates of emergency surgery increased stepwise from 1% at a score ≤ 1 to almost 40% at a score ≥ 8 with linear calibration plots. Conclusions The SIM score was developed and validated to accurately estimate the need for emergent thoracotomy and/or laparotomy in MVC victims.

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Resuscitative endovascular balloon occlusion of the aorta (REBOA) is associated with improved survival in severely injured patients: A propensity score matching analysis

Yamamoto R., Cestero R., Suzuki M., Funabiki T., Sasaki J.

American Journal of Surgery （American Journal of Surgery）  218 （ 6 ） 1162 - 1168 2019年

研究論文（学術雑誌）, 共著, 査読有り,  ISSN  0002-9610

　概要を見る

© 2019 Elsevier Inc. Background: Resuscitative endovascular balloon occlusion of the aorta (REBOA) is a technique for temporary control of arterial hemorrhage. However, its effectiveness and clinical outcomes are unclear. Methods: Using a nationwide database (2004–2016) in Japan, trauma patients with survival data were identified. Patients were divided between REBOA and non-REBOA groups, and a propensity score was developed using multivariate logistic regression. Survival to discharge was compared between the groups after propensity score matching. Results: Among 82,371 patients included in this study, 385 were treated with REBOA. After propensity score matching, 117 pairs were selected. Survival to discharge was significantly higher among patients treated with REBOA than among those treated without REBOA (53 [45.3%] vs. 38 [32.5%]; odds ratio = 1.72; 95% CI = 1.01–2.93; p = 0.04). Conclusions: REBOA use was associated with improved survival to discharge and should therefore be considered during the management of severely injured trauma patients.

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Damage control orthopedics and decreased in-hospital mortality: A nationwide study

Yamamoto R., Udagawa K., Nishida Y., Ono S., Sasaki J.

Injury （Injury）  50 （ 12 ） 2240 - 2246 2019年

研究論文（学術雑誌）, 共著,  ISSN  00201383

　概要を見る

© 2019 Introduction: While various strategies of fracture fixation in trauma victims have been discussed, the effect of damage control orthopedics (DCO) on significant clinical outcome is inconclusive. We examined the mortality of patients managed with DCO, comparing those without DCO, using a nationwide trauma database. Patients and Methods: We retrospectively identified patients with extremity injury, defined as patients with an Abbreviated Injury Scale (AIS) of ≥2 in an upper or lower extremity, in the database that included more than 200 major hospitals from 2004 to 2016. We included those who were age ≥15 years and underwent ORIF. Patients with missing survival data or invalid vital signs at hospital arrival were excluded. Patient data were divided into DCO or non-DCO groups, and propensity scores were developed to estimate the probability of being assigned to the DCO group, using multivariate logistic regression analyses adjusted for known survival predictors, such as age, vital signs at arrival, Abbreviated Injury Scale in extremity, ISS, presence of vascular injury, surgical procedure before fracture treatment, and transfusion requirement. The primary outcome, in-hospital mortality, was compared between the two groups after propensity score matching. Survival analyses were performed, and hazard ratio was adjusted according to age, systolic blood pressure on arrival, and Injury Severity Score. Results: Of the 19,319 patients included in this study, 4407 (22.8%) underwent DCO. After the propensity score matching, 3858 pairs were selected. In-hospital mortality was significantly lower among patients in the DCO than those in the non-DCO groups (40 [1.0%] vs. 66 [1.7%]; odds ratio = 0.60; 95% confidence interval [CI] = 0.41–0.89; P = 0.01). Survival analyses showed that DCO was independently associated with decreased mortality in patients with extremity injury (adjusted hazard ratio = 0.30; 95% CI = 0.20–0.46; P < 0.01). Conclusions: DCO was associated with decreased in-hospital mortality in patients with major fractures. Further clinical study on DCO by selecting patient population should be considered eventually to develop an appropriate strategy for major fractures.

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Early Complications Following Facial Laceration Repair Performed by Emergency Physicians After One Year of Wound Closure Training.

Yamamoto R, Homma K, Masuzawa Y, Shimizu C, Ogata T, Hori S, Sasaki J

AEM education and training （AEM Education and Training）  2 （ 4 ） 259 - 268 2018年10月

共著

　概要を見る

© 2018 by the Society for Academic Emergency Medicine Objective: Facial lacerations, which are common in the emergency department, have usually been repaired by non–facial trauma specialists, such as emergency physicians. Given the ongoing discussion regarding quality assurance or the optimal training model on facial laceration repair for nonspecialists, we sought to determine the impact of a 1-year wound closure training provided to emergency physicians. We hypothesized a decrease in early complications following facial wound closure after the training. Methods: A retrospective observational study was conducted between 2013 and 2015 at an academic center. We included patients with isolated facial lacerations that were repaired by emergency physicians and reviewed by board-certified plastic surgeons during a follow-up visit. Patients whose wounds were not reviewed within 3 days were excluded. The 1-year training curriculum, which consisted of several sessions of lecture, hands-on practice, and case review, had been developed by a multidisciplinary team and provided to emergency physicians. Patient data were divided between nonparticipant and participant groups, and a propensity score was developed to estimate the probability of being assigned to the participant group. The incidence of early complications, defined as the need for additional suturing or resuturing due to wound dehiscence, was compared among the groups after propensity score matching. Results: Although 132 patients satisfied all the inclusion criteria, 11 were excluded due to delayed initial wound review. Among the 70 patients who were eventually included in the participant group, 40 were matched with those in the nonparticipant group. The incidence of early complications was significantly lower in the participant group than in the nonparticipant group (5.0% vs. 20.0%, odds ratio = 0.21, 95% confidence interval = 0.07–0.61, p = 0.04). Conclusions: The 1-year training provided to emergency physicians reduced the incidence of early complications following facial laceration repair. Accordingly, future wound closure training models should consider the 1-year training curriculum presented herein.

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Rapid decay of transthoracic echocardiography skills at 1 month: A prospective observational study

Yamamoto R., Clanton D., Willis R., Jonas R., Cestero R.

Journal of Surgical Education （Journal of Surgical Education）  75 （ 2 ） 503 - 509 2018年03月

研究論文（学術雑誌）, 共著,  ISSN  19317204

　概要を見る

© 2017 Association of Program Directors in Surgery Objective: Focused transthoracic echocardiography (FTTE) is an emerging tool in the management of critically ill patients, but the lack of adequate training models has limited the expansion of this technology. Although basic FTTE training courses have been shown to be sufficient in developing echocardiography skills, limited data exist regarding skill retention. In an effort to develop an adequate FTTE training model, we sought to determine the degree of skill retention after FTTE training. Design: A prospective, observational study. Setting: An academic center. Participants: Surgical residents and medical students: 31 subjects were enrolled from February to June 2016. Results: Participants underwent a 2-hour FTTE course including didactics and a hands-on session measuring ejection fraction of left ventricle (LV) and inferior vena cava (IVC) diameter. Written knowledge and performance examinations applying FTTE were conducted before the course, immediately after, and at 1- and 3-month intervals, which were evaluated on a 0 to 9 scale and analyzed with paired t-tests. Performance examination scores obtaining the LV and IVC views preinitial and postinitial training increased from 1.7 to 6.5 (LV) and from 2.0 to 6.8 (IVC) (p < 0.01), decreased to 5.0 and 4.8, respectively, at 1 month (posttraining vs 1 month, p < 0.01), and did not significantly change at 3 months (5.4 and 5.0, respectively). Written examination scores increased from 42% to 62% (pretraining vs posttraining, p < 0.01), decreased to 48% in 1 month (posttraining vs 1 month, p < 0.01), and further decreased to 34% at 3 months (1 month vs 3 month, p < 0.01). Conclusions: Although a short training course appears sufficient to impart basic FTTE skills and knowledge, skills are significantly decayed at 1 month and knowledge continually decreases at 1 and 3 months. Future FTTE training models should consider the rapid degradation of knowledge and skills in determining frequency of refresher training and ongoing evaluation.

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Colon Trauma: Evidence-Based Practices

Yamamoto R., Logue A., Muir M.

Clinics in Colon and Rectal Surgery （Clinics in Colon and Rectal Surgery）  31 （ 1 ） 11 - 16 2018年01月

共著,  ISSN  15310043

　概要を見る

© 2018 by Thieme Medical Publishers, In. Colon injury is not uncommon and occurs in about a half of patients with penetrating hollow viscus injuries. Despite major advances in the operative management of penetrating colon wounds, there remains discussion regarding the appropriate treatment of destructive colon injuries, with a significant amount of scientific evidence supporting segmental resection with primary anastomosis in most patients without comorbidities or large transfusion requirement. Although literature is sparse concerning the management of blunt colon injuries, some studies have shown operative decision based on an algorithm originally defined for penetrating wounds should be considered in blunt colon injuries. The optimal management of colonic injuries in patients requiring damage control surgery (DCS) also remains controversial. Studies have recently reported that there is no increased risk compared with patients treated without DCS if fascial closure is completed on the first reoperation, or that a management algorithm for penetrating colon wounds is probably efficacious for colon injuries in the setting of DCS as well.

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鈍的外傷による心肺停止患者に対する救急室開胸の適応に関する検討

山元 良, 中間 楽平, 加瀬 建一, 関根 和彦, 栗原 智宏, 佐々木 淳一

日本救急医学会雑誌 （(一社)日本救急医学会）  28 （ 9 ） 454 - 454 2017年09月

査読有り,  ISSN  0915-924X

SSCG（surviving sepsis campaign guidelines）2016．

山元良, 藤島清太郎

Thrombosis Medicine （先端医学社）   （ 4 ） 85 - 88 2017年

腹部緊急手術を施行した敗血症性DIC症例に関する検討

山元 良, 篠崎 浩治, 加瀬 建一, 小林 健二

日本腹部救急医学会雑誌 （Japanese Society for Abdominal Emergency Medicine）  35 （ 3 ） 195 - 200 2015年

ISSN  1340-2242

　概要を見る

トロンボモジュリン製剤である遺伝子組換え型ヒトトロンボモジュリンは，敗血症性DICの治療薬として近年注目されてきているが，腹部緊急手術後の使用に注目した研究は少ない。そこで，当院で過去約3年間に経験した腹部緊急手術を要した敗血症性DIC症例を対象に，同製剤の使用と周術期の治療成績を後方視的に検討した。投与群24例，非投与群19例であり，投与群でAPACHE Ⅱ scoreが有意に高く (p＝0.02），術後ICU入室率，人工呼吸器使用率が高かった (p＜0.001，p＝0.004）。出血性合併症や死亡率に有意差はなく，投与群では敗血症性DIC診断後の新鮮凍結血漿の投与量が少なかった (p＝0.02）。以上により，同製剤は腹部緊急手術の周術期でも安全に使用できることが確認され，敗血症性DIC診断後の輸血量を減らせる可能性が示唆された。

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大動脈遮断バルーンカテーテル(IABO)による重症外傷症例の救命率向上と合併症対策

折田 智彦, 船曳 知弘, 山崎 元靖, 清水 正幸, 松本 松圭, 豊田 幸樹年, 山元 良, 佐久間 淳, 風巻 拓, 山根 隆, 井上 征雄, 松坂 陽至, 北野 光秀

IVR: Interventional Radiology （(一社)日本インターベンショナルラジオロジー学会）  28 （ Suppl. ） 177 - 177 2013年04月

ISSN  1340-4520

腹部救急における血液浄化療法の実際 大腸穿孔による敗血症性ショックに対する術後エンドトキシン吸着療法(PMX-DHP)の循環蘇生効果 トロンボモジュリン製剤の併用効果も含めて

折田 智彦, 豊田 幸樹年, 山崎 元靖, 船曵 知弘, 清水 正幸, 松本 松圭, 山元 良, 佐久間 淳, 風巻 拓, 北野 光秀

日本腹部救急医学会雑誌 （(一社)日本腹部救急医学会）  33 （ 2 ） 323 - 323 2013年02月

ISSN  1340-2242

MDCTで造影剤血管外漏出を認めた下血患者に対する経カテーテル動脈塞栓術

風巻 拓, 船曳 知弘, 折田 智彦, 山元 良, 豊田 幸樹年, 松本 松圭, 清水 正幸, 山崎 元靖, 北野 光秀

日本救急医学会雑誌 （(一社)日本救急医学会）  23 （ 10 ） 586 - 586 2012年10月

ISSN  0915-924X

腸重積にて発症した小腸悪性リンパ腫に対して腹腔鏡補助下に切除した2例

安部 望, 吉川 貴久, 中島 秀明, 岩野 雄一, 永 滋教, 山元 良, 寺内 寿彰, 遠藤 和宏, 木全 大, 篠崎 浩治, 小林 健二, 尾形 佳郎

日本臨床外科学会雑誌 （日本臨床外科学会）  71 （ 増刊 ） 882 - 882 2010年10月

ISSN  1345-2843

孤発性腹腔動脈解離に対して抗凝固療法を施行し軽快した一例

小倉 崇以, 冨岡 秀人, 岩野 雄一, 多村 知剛, 駒ヶ嶺 順平, 山元 良, 石山 正也, 宮武 諭, 加瀬 健一, 小林 健二

日本救急医学会雑誌 （(一社)日本救急医学会）  21 （ 8 ） 576 - 576 2010年08月

ISSN  0915-924X

脳幹梗塞で発症し24時間以内にくも膜下出血を続発した解離性脳底動脈瘤の一例

多村 知剛, 宮武 諭, 吉田 真貴, 岩野 雄一, 山元 良, 駒ヶ嶺 順平, 石山 正也, 白井 利行, 富岡 秀人, 加瀬 健一, 小林 健二

日本救急医学会雑誌 （(一社)日本救急医学会）  21 （ 8 ） 569 - 569 2010年08月

ISSN  0915-924X

急性胆嚢炎に伴う右肝動脈仮性動脈瘤胆嚢内穿破にて胆道出血と急性膵炎を発症した一例

山元 良, 加瀬 建一, 小倉 崇以, 岩野 雄一, 多村 知剛, 駒ヶ嶺 順平, 石山 正也, 白井 利行, 冨岡 秀人, 宮武 諭, 小林 健二

日本救急医学会雑誌 （(一社)日本救急医学会）  21 （ 8 ） 676 - 676 2010年08月

ISSN  0915-924X

Stonefish "Okoze" envenomation during food preparation

Ryo Yamamoto, Masaru Suzuki, Shingo Hori, Naoki Aikawa

Keio Journal of Medicine 59 （ 1 ） 19 - 22 2010年03月

ISSN  0022-9717

　概要を見る

Stonefish is a dangerous and venomous fish commonly found in the shallow waters of the Pacific region. Its envenomation is reported worldwide with increasing frequency. Although envenomation usually occurs in those engaged in marine sports, chefs may suffer envenomation during cutting stonefish, which is eaten either sliced raw, boiled, or deep-fried by Japanese. Since many people cook and eat Japanese food, it is important to know that cutting a stonefish for cooking carries the risk of envenomation. However, most primary and emergency physicians have not encountered cases of envenomation during food preparation. Here we describe a case of envenomation occurring while cooking. The patient was a healthy 33-year-old man working as a chef in a Japanese restaurant. He was presented to an academic emergency department after suddenly developing severe pain in his right fourth finger while cutting a stonefish. The finger was reddish, swollen, and tender. The pain reduced after immersing his hand in hot water, and disappeared within 18 h without any complication. In this report, we describe the history of stonefish envenomation and provide a brief review of the literature related to this form of envenomation.

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