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A nationwide longitudinal survey of infantile injury and its recurrence in Japan. 国際誌

Tomohiro Hiraoka, Takafumi Obara, Naomi Matsumoto, Kohei Tsukahara, Takashi Hongo, Tsuyoshi Nojima, Masaki Hisamura, Tetsuya Yumoto, Atsunori Nakao, Takashi Yorifuji, Hiromichi Naito

Scientific reports 14 ( 1 ) 24716 - 24716 2024年10月

記述言語：英語掲載種別：研究論文（学術雑誌）

Injury recurrence in young children is a significant public health concern, as it may indicate an unfavorable home environment. This study evaluates whether infantile injuries increase recurrence during preschool years, contributing to more effective prevention strategies for vulnerable families. The study included 20,191 children from "The Longitudinal Survey of Babies in the 21st Century," a representative sample of infants born in Japan between May 10 and 24, 2010. We conducted a logistic regression analysis to compare injury recurrence risk between children aged 18 months to seven years with and without infantile injury histories. The study revealed that infants with a history of injuries had a higher risk of subsequent hospital visits for injuries during preschool years (crude Odds Ratio (cOR) 1.52, 95% CI, 1.41-1.64, adjusted OR (aOR) 1.48, 95% CI 1.37-1.60). Specific injuries, such as falls (aOR 1.34, 95% CI, 1.26-1.43), pinches (aOR 1.22, 95% CI, 1.15-1.29), drowning (aOR 1.29, 95% CI, 1.19-1.40), ingestion (aOR 1.35, 95% CI, 1.17-1.55), and burns (aOR 1.47, 95% CI, 1.31-1.65), independently increased the risk of future injuries. Our findings highlight the necessity of universal safety measures in the home environment and targeted interventions for families with a history of high-risk injuries.

DOI： 10.1038/s41598-024-76403-z

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Management of Obesity Hypoventilation Syndrome in Extreme Obesity: A Case Study. 国際誌

Yuya Miyoshi, Tetsuya Yumoto, Yoshinori Kosaki, Takashi Hongo, Kohei Tsukahara, Atsunori Nakao, Hiromichi Naito

The American journal of case reports 25 e945112 2024年10月

記述言語：英語掲載種別：研究論文（学術雑誌）

BACKGROUND Obesity hypoventilation syndrome (OHS) is characterized by hypercapnia in obese patients, with acute hypercapnic respiratory failure often worsened by various conditions. Managing super-super obese patients presents complex challenges in critical care. Our case report details the successful treatment of acute respiratory failure in a patient with a body mass index (BMI) over 80 kg/m², highlighting the importance of comprehensive, multidisciplinary care in the Intensive Care Init (ICU). CASE REPORT A 39-year-old man with a BMI of 81.1 kg/m² presented to our emergency department with respiratory distress, altered consciousness, and an inability to move independently. Arterial blood gas analysis revealed severe hypercapnia and hypoxemia, indicating decompensated OHS. Laboratory tests and computed tomography scans suggested his condition was exacerbated by pneumonia and congestive heart failure. The patient was managed in the ICU with endotracheal intubation, mechanical ventilation, and esophageal pressure monitoring. In addition to antibiotics, diuretics were used to manage fluid balance. His care included multidisciplinary support with nutritional management and active physiotherapy. After 15 days, he was weaned from the ventilator and discharged from the ICU on day 20, continuing rehabilitation until he was discharged home on day 60. CONCLUSIONS This case report describes the successful treatment of acute hypercapnic respiratory failure from decompensated OHS in a super-super obese patient. Addressing the underlying conditions and tailoring clinical practices to the patient's specific needs, especially regarding ventilatory support, fluid balance, and nutrition, were crucial. A collaborative multidisciplinary approach was essential for improving outcomes.

DOI： 10.12659/AJCR.945112

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Reply to: The gray-white matter ratio in adult out-of-hospital cardiac arrest patients must be assessed comprehensively. 国際誌

Takashi Hongo, Hiromichi Naito, Tetsuya Yumoto, Atsunori Nakao

Resuscitation 110383 - 110383 2024年9月

Association between signs of life and survival in traumatic cardiac arrest patients: A nationwide, retrospective cohort study. 国際誌

Takafumi Obara, Tetsuya Yumoto, Naofumi Bunya, Tsuyoshi Nojima, Tomohiro Hiraoka, Takashi Hongo, Yoshinori Kosaki, Kohei Tsukahara, Takenori Uehara, Atsunori Nakao, Hiromichi Naito

Resuscitation plus 19 100701 - 100701 2024年9月

記述言語：英語掲載種別：研究論文（学術雑誌）

BACKGROUND: The clinical impact of signs of life (SOLs) in traumatic cardiac arrest (TCA) remains to be elucidated. The aim of this study was to examine the association between SOLs and survival/neurological outcomes in TCA patients. METHODS: Retrospective data from the Japan Trauma Data Bank (2019-2021) was reviewed. TCA patients were assigned to one of two study groups based on the presence or absence of SOLs and compared. SOLs were defined as having at least one of following criteria: pulseless electrical activity >40 beats per minute, gasping, positive light reflex, or extremity/eye movement at hospital arrival. The primary outcome was survival at hospital discharge. The secondary outcome was favorable neurological status (Glasgow Outcome Scale score of 4 or 5) at hospital discharge. RESULTS: A total of 1,981 patients (114 with SOLs and 1,867 without SOLs) were included. Characteristics of patients were as follows: age (median age 60.0 years old [interquartile range: 41-80] years vs. 55.4 [38-75] years), gender (male: 76/114 (66.7%) vs. 1,207/1,867 (65.0%), blunt trauma (90/111 [81.1%] vs. 1,559/1,844 [84.5%]), Injury Severity Score (29.2 [22-41] vs. 27.9 [20-34]). Patients with SOLs showed higher survival (10/114 (8.8%) vs. 25/1,867 (1.3%), OR 1.96 [CI 1.20-2.72]) and higher favorable neurological outcomes (4/110 (3.5%) vs. 6/1,865 (0.3%), OR 2.42 [CI 1.14-3.70]) compared with patients without SOLs. CONCLUSIONS: TCA patients with SOLs at hospital arrival showed higher survival and favorable neurological outcomes at hospital discharge compared with TCA patients without SOLs.

DOI： 10.1016/j.resplu.2024.100701

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Prognostic value of grey-white matter ratio obtained within two hours after return of spontaneous circulation in out-of-hospital cardiac arrest survivors: A multicenter, observational study. 国際誌

Yuya Murakami, Takashi Hongo, Tetsuya Yumoto, Yoshinori Kosaki, Atsuyoshi Iida, Hiroki Maeyama, Fumiya Inoue, Toshihisa Ichiba, Atsunori Nakao, Hiromichi Naito

Resuscitation plus 19 100746 - 100746 2024年9月

記述言語：英語掲載種別：研究論文（学術雑誌）

BACKGROUND: Grey-white matter ratio (GWR) measured by head computed tomography (CT) scan is known as a neurological prognostication tool for out-of-hospital cardiac arrest (OHCA) survivors. The prognostic value of GWR obtained early (within two hours after return of spontaneous circulation [ROSC]) remains a matter of debate. METHODS: We conducted a multicenter, retrospective, observational study at five hospitals. We included adult OHCA survivors who underwent head CT within two hours following ROSC. GWR values were measured using head CT. Average GWR values were calculated by the mean of the GWR-basal ganglia and GWR-Cerebrum. We divided the patients into poor or favorable neurological outcome groups defined by Glasgow-Pittsburgh Cerebral Performance Category scores. The predictive accuracy of GWR performance was assessed using the area under the curve (AUC). The sensitivities and specificities for predicting poor outcome were examined. RESULTS: Of 377 eligible patients, 281 (74.5%) showed poor neurological outcomes at one month after ROSC. Average GWR values of the poor neurological outcome group were significantly lower than those of the favorable neurological outcome. The average GWR value to predict neurological outcome with Youden index was 1.24 with AUC of 0.799. When average GWR values were 1.15 or lower, poor neurological outcomes could be predicted with 100% specificity. CONCLUSIONS: GWR values measured by head CT scans early (within two hours after ROSC) demonstrated moderate predictive performance for overall ROSC patients. When limited to the patients with GWR values of 1.15 or lower, poor neurological outcomes could be predicted with high specificity.

DOI： 10.1016/j.resplu.2024.100746

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移植医療における診療連携(術前、術後管理/集中治療) 岡山大学病院での脳死下臓器提供のプロセスにおける連携と取り組み救急集中治療の立場から

湯本哲也, 小原隆史, 塚原紘平, 内藤宏道, 中尾篤典

移植 59 ( 総会臨時 ) 148 - 148 2024年9月

臓器提供支援事業の現状と課題岡山県の臓器提供施設連携体制構築事業

内藤宏道, 塚原紘平, 湯本哲也, 本郷貴織, 小崎吉訓, 小原隆史, 野島剛, 上田浩平, 飯田淳義, 久村正樹, 安田和広, 中尾篤典

移植 59 ( 総会臨時 ) 231 - 231 2024年9月

私(僕)の臨床研究、興味ありませんか? 救急集中治療の現場で臨床医が取り組む「小児」のデータベース研究の可能性

小原隆史, 内藤宏道, 塚原紘平, 本郷貴識, 野島剛, 湯本哲也, 中尾篤典

日本集中治療医学会雑誌 31 ( Suppl.1 ) S485 - S485 2024年9月

ドナー管理における臓器保護に関する取り組み小児のドナー管理における多臓器不全の経時的変化単施設後方視的観察研究

小原隆史, 塚原紘平, 湯本哲也, 内藤宏道, 中尾篤典

移植 59 ( 総会臨時 ) 233 - 233 2024年9月

私(僕)の臨床研究、興味ありませんか? 救急集中治療の現場で臨床医が取り組む「小児」のデータベース研究の可能性

小原隆史, 内藤宏道, 塚原紘平, 本郷貴識, 野島剛, 湯本哲也, 中尾篤典

日本集中治療医学会雑誌 31 ( Suppl.1 ) S485 - S485 2024年9月

筋肉量評価の最新ノウハウ!多職種チームがICUのカラダを測り尽くす PCAS管理中の側頭筋の萎縮

本郷貴識, 村上勇也, 劉啓文, 松岡綾華, 土手尚, 三池慧, 上田浩平, 湯本哲也, 内藤宏道, 中尾篤典

日本集中治療医学会雑誌 31 ( Suppl.1 ) S443 - S443 2024年9月

臓器提供支援事業の現状と課題岡山県の臓器提供施設連携体制構築事業

内藤宏道, 塚原紘平, 湯本哲也, 本郷貴織, 小崎吉訓, 小原隆史, 野島剛, 上田浩平, 飯田淳義, 久村正樹, 安田和広, 中尾篤典

移植 59 ( 総会臨時 ) 231 - 231 2024年9月

Prognostic Performance of Gray-White Matter Ratio in Adult Out-of-Hospital Cardiac Arrest Patients after Receiving Extracorporeal Cardiopulmonary Resuscitation. 国際誌

Takashi Hongo, Hiromichi Naito, Michitaka Nasu, Tetsuya Yumoto, Yoshinori Kosaki, Takashi Yorifuji, Toru Hifumi, Akihiko Inoue, Tetsuya Sakamoto, Yasuhiro Kuroda, Atsunori Nakao

Resuscitation 110351 - 110351 2024年8月

記述言語：英語掲載種別：研究論文（学術雑誌）

BACKGROUND: Gray-to-white matter ratio (GWR), measured by computed tomography (CT), is commonly used to predict poor neurological outcomes after out-of-hospital cardiac arrest (OHCA). The prognostic performance of GWR in OHCA patients receiving extracorporeal cardiopulmonary resuscitation (ECPR) is not known. METHODS: This study is a secondary analysis of data from the SAVE-J II registry, a retrospective, multicenter study. Participants were divided into four groups according to average GWR (aGWR) values ranging from 1.00 to 1.39, separated by 0.1 intervals. The aGWR values were calculated for bilateral basal ganglia, centrum semiovale, and high convexity obtained by head CT within 24 h after ECPR. Primary outcome was poor neurological outcomes at 30-day. RESULTS: In total, 1,146 OHCA patients treated with ECPR were included in our analysis. Overall, participants with lower aGWR more likely had poor neurological outcomes, aGWR 1.00-1.09 (94.6%), aGWR 1.10-1-19 (87.8%), aGWR 1.20-1.29 (78.5%), and aGWR 1.30-1.39 (70.3%). Multivariable logistic regression showed that lower aGWR was associated with poor neurological outcome at 30-day, aGWR 1.30-1.39: reference, aGWR 1.00-1.09: adjusted odds ratio (aOR) 10.01 (95% confidence interval (CI) [3.58-27.99]), aGWR 1.10-1.19: aOR 4.83 (95% CI [2.31-10.12]), aGWR 1.20-1.29: aOR 2.16 (95% CI [1.02-4.55]). Receiver operating characteristic curve analysis revealed that the prognostic performance of aGWR had an area under the curve of 0.628, 95% CI [0.59-0.66]). The aGWR threshold of 1.005 for predicting poor neurological outcome reached 100% specificity with 0.1% sensitivity. CONCLUSION: Early neuro-prognostication depending on GWR may not be sufficient after ECPR and requires a multimodal approach.

DOI： 10.1016/j.resuscitation.2024.110351

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Evolution and Effects of Ad Hoc Multidisciplinary Team Meetings in the Emergency Intensive Care Unit: A Five-Year Analysis. 国際誌

Tetsuya Yumoto, Takashi Hongo, Takafumi Obara, Kohei Ageta, Toshiyuki Aokage, Kohei Tsukahara, Atsunori Nakao, Hiromichi Naito

Journal of clinical medicine 13 ( 15 ) 2024年7月

記述言語：英語掲載種別：研究論文（学術雑誌）

Background: Multidisciplinary team meetings (MDTMs) are crucial in the ICU. However, daily rounds may not address all sensitive issues due to time constraints and the complexity of cases. This study aimed to describe detailed information and characteristics of ad hoc MDTMs in the ICU. Methods: This single-center, retrospective study analyzed adult emergency ICU admissions at Okayama University Hospital from 1 January 2019 to 31 December 2023. During this period, weekly regular multidisciplinary team ICU rounds were introduced in June 2020, and regular weekday morning MDTMs began in April 2022. A multiple logistic regression analysis was applied to determine the impact of these changes on the frequency of ad hoc MDTMs, adjusting for variables including annual changes. Results: The study analyzed 2487 adult EICU patients, with a median age of 66, and 63.3% of them male. MDTMs were held for 168 patients (6.8%), typically those with severe conditions, including higher COVID-19 prevalence and APACHE II scores, and longer ICU stays. Despite a constant total number of MDTMs, the likelihood of conducting ad hoc MDTMs increased annually (adjusted OR 1.19; 95% CI, 1.04-1.35). Of the 329 MDTMs conducted for these patients, 59.0% addressed end-of-life care, involving an average of 11 participants, mainly nurses and emergency and critical-care physicians. Conclusions: Changes in ICU round and meeting structures might be associated with a higher frequency of conducting ad hoc MDTMs, highlighting their evolving role and importance in patient care management.

DOI： 10.3390/jcm13154324

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アセトアミノフェンと鉄剤を大量内服し、血漿交換を行った肝障害の一例

小崎吉訓, 松尾逸平, 薬師寺泰匡, 野島剛, 塚原紘平, 内藤宏道, 中尾篤典

中毒研究 37 ( 2 ) 252 - 252 2024年7月