Faculty Profiles - SHIMIZU Kazuyoshi

Papers - SHIMIZU Kazuyoshi

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Long-term outcomes in patients treated in the intensive care unit after hematopoietic stem cell transplantation. Reviewed

Makoto Nakamura, Nobuharu Fujii, Kazuyoshi Shimizu, Shuntaro Ikegawa, Keisuke Seike, Tomoko Inomata, Yasuhisa Sando, Keiko Fujii, Hisakazu Nishimori, Ken-Ichi Matsuoka, Hiroshi Morimatsu, Yoshinobu Maeda

International journal of hematology 108 ( 6 ) 622 - 629 2018.12

Language：English Publishing type：Research paper (scientific journal)

The number of patients who are successfully discharged from the intensive care unit (ICU) after hematopoietic stem cell transplantation (HSCT) remains limited. Most previous studies have evaluated short-term outcomes using ICU mortality; there have been comparatively fewer reports of long-term outcomes. We retrospectively analyzed 39 HSCT patients admitted to the ICU for the first time between April 2008 and July 2014. Performance status was evaluated in four long-term survivors in July 2016. Median age at ICU admission was 54 years (range 30-68). In total, 33 patients (70.2%) required mechanical ventilation and 31 patients (66%) required dialysis. The median OS from first ICU admission was 41 days (95% confidence interval [CI]: 22-64) and the 1-year survival rate was 12.8% (95% CI 4.7-25.2). No statistically significant factors were associated with short-term outcomes. Among long-term outcomes, a second or subsequent HSCT and neutropenia at ICU admission were significant risk factors. Four of 10 ICU survivors have survived with good performance status for a median of 1994 (1203-2633) days. Our results suggest that the number of prior transplants and neutropenia at ICU admission may influence OS.

DOI： 10.1007/s12185-018-2536-x

High Ionized Calcium Concentration Is Associated With Prolonged Length of Stay in the Intensive Care Unit for Postoperative Pediatric Cardiac Patients. Reviewed International journal

Satoshi Kimura, Tatsuo Iwasaki, Katsunori Oe, Kazuyoshi Shimizu, Tomohiko Suemori, Tomoyuki Kanazawa, Naohiro Shioji, Yasutoshi Kuroe, Yuto Matsuoka, Hiroshi Morimatsu

Journal of cardiothoracic and vascular anesthesia 32 ( 4 ) 1667 - 1675 2018.8

Language：English Publishing type：Research paper (scientific journal)

OBJECTIVE: There has been controversy regarding the beneficial effects of calcium on myocardial contractility and the harmful effects on myocardial cells, especially in children. The aim of this study was to investigate an association between ionized calcium concentration (iCa) and outcomes for pediatric patients after cardiac surgery. DESIGN: A retrospective, single-center study from May 2013 to December 2014. SETTING: Referral high-volume pediatric cardiac center in a tertiary teaching hospital. PATIENTS: Patients <72 months old with congenital heart disease who underwent palliative or definitive surgery. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: The association between pH-corrected iCa within 24 hours after surgery and intensive care unit (ICU) length of stay (ILOS) was defined as the primary outcome. The highest iCa (iCamax), lowest iCa (iCamin), and time-weighted average iCa (iCaave) were stratified and compared with the outcomes. The authors reviewed 5,468 ionized calcium measurements from 357 consecutive pediatric patients during the study period. One patient died at postoperative day 34 in the ICU. Significant differences in ILOS were observed among patients after cardiopulmonary bypass (CPB) according to iCaave, iCamax, and iCamin but not among patients without CPB. Patients with CPB and an iCaave value of 1.31-to-1.40 mmol/L, 1.41-to-1.50 mmol/L, 1.51-to-1.60 mmol/L, and >1.60 mmol/L stayed in the ICU for 7 (interquartile range [IQR] 4-10) days, 8 (IQR 6-16) days, 10 (IQR 8-14) days, and 19 (IQR 12-38) days, respectively, which was significantly longer than the ILOS of 5 (4-8) days for patients with an iCaave of 1.21-to-1.30 mmol/L. Even after adjustment for other predictors of ILOS using multivariable analyses, there were significant relationships of ILOS with iCaave and iCamin values of >1.50 mmol/L among patients with CPB. CONCLUSIONS: Higher iCa within 24 hours after congenital cardiac surgery using CPB was independently associated with longer LOS in the ICU.

DOI： 10.1053/j.jvca.2017.11.006

Perioperative Management of a Child With Glucose Transporter Type 1 Deficiency Syndrome: A Case Report. Reviewed International journal

Tsubasa Yoshida, Kazuyoshi Shimizu, Satoshi Suzuki, Yoshikazu Matsuoka, Hiroshi Morimatsu

A&A practice 11 ( 2 ) 35 - 37 2018.7

Language：English Publishing type：Research paper (scientific journal)

Glucose transporter type 1 deficiency syndrome (GLUT1DS) causes central nervous system dysfunction including intractable epilepsy caused by impaired glucose transport to the brain. To prevent convulsions and maintain an energy source for the brain in patients with GLUT1DS, the maintenance of adequate ketone body concentrations, compensation of metabolic acidosis, and reduction of surgical stress are essential. We here report the perioperative management of a child with GLUT1DS.

DOI： 10.1213/XAA.0000000000000727

Perioperative respiratory management in high risk patients Reviewed

Shuji Okahara, Kazuyoshi Shimizu, Naohiro Shioji, Hiroshi Morimatsu

Japanese Journal of Anesthesiology 67 ( 5 ) 511 - 517 2018.5

Language：Japanese Publishing type：Research paper (scientific journal) Publisher：Kokuseido Publishing Co. Ltd

Mechanical ventilation during surgery was thought to be easy, because it is only of short duration, and it is used for paralyzed, healthy lungs. Recently, however, it is reported that high risk patients are increasing in number and the actual incidence of postoperative pulmonary complications (PPC) is as high as 20-30%. Nowadays, we should pay more attentions to perioperative respiratory care especially in high risk patients. In preoperative periods, several risk calculation systems has been already reported, but their validation and routine use are still limited We really have to pay more attention in predicting high risk patients for PPC. During general anesthesia, lung protective ventilation could be applied especially in high risk patients, and it could reduce PPC. After surgery, high flow nasal cannula can be used to prevent re-intubation, but it is not known whether this approach could reduce PPC. Of course, more evidence is needed, but we suggest that anesthesiologists should pay more attention not only to maintenance of anesthesia during surgery, but also to prevention of PPC by perioperative respiratory care.

胸腺腫摘出術後の抜管時に冠動脈攣縮から心停止に至った1例 Reviewed

吹田晃享, 清水一好, 金澤伴幸, 松岡義和, 森松博史

日本臨床麻酔学会誌 38 ( 2 ) 142 - 147 2018.3

Language：Japanese Publisher：日本臨床麻酔学会

胸腺腫摘出術術後の抜管時に冠動脈攣縮から心停止に至ったと考えられる1例を経験した。症例は60歳、男性。術前評価で冠動脈器質的異常を認めなかったが、喫煙など複数の冠攣縮危険因子を有していた。腫瘍の浸潤性や術中循環動態の不安定性から、胸骨正中切開、静脈バイパス併用下胸腺腫摘出手術を行った。手術終了後にST上昇先行の心停止を発症したが、蘇生後の心機能回復は良好で、後遺症なく独歩退院した。術後の冠動脈攣縮誘発試験陽性から、心停止の原因は冠攣縮が強く疑われた。高侵襲手術などの手術因子、麻酔覚醒や薬剤投与などの術中因子が合わさり、冠攣縮に伴う心停止に至ったと考えられた。(著者抄録)

Other Link： https://search.jamas.or.jp/default/link?pub_year=2018&ichushi_jid=J01620&link_issn=&doc_id=20180319160002&doc_link_id=%2Fci4jjsca%2F2018%2F003802%2F002%2F0142-0147%26dl%3D0&url=https%3A%2F%2Fwww.medicalonline.jp%2Fjamas.php%3FGoodsID%3D%2Fci4jjsca%2F2018%2F003802%2F002%2F0142-0147%26dl%3D0&type=MedicalOnline&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00004_2.gif

Diastolic Dysfunction Is a Risk of Perioperative Myocardial Injury Assessed by High-Sensitivity Cardiac Troponin T in Elderly Patients Undergoing Non-Cardiac Surgery. Reviewed

Hironobu Toda, Kazufumi Nakamura, Koji Nakagawa, Atsuyuki Watanabe, Toru Miyoshi, Nobuhiro Nishii, Kazuyoshi Shimizu, Masao Hayashi, Hiroshi Morita, Hiroshi Morimatsu, Hiroshi Ito

Circulation journal : official journal of the Japanese Circulation Society 82 ( 3 ) 775 - 782 2018.2

Language：English Publishing type：Research paper (scientific journal)

BACKGROUND: High-sensitivity cardiac troponin T (hs-cTnT) is useful for detecting myocardial injury and is expected to become a prognostic marker in patients undergoing non-cardiac surgery. The aim of this pilot study evaluating the efficacy of β-blocker therapy in a perioperative setting (MAMACARI study) was to assess perioperative myocardial injury (PMI) in elderly patients with preserved ejection fraction (EF) undergoing non-cardiac surgery.Methods and Results:In this prospective observational cohort study of 151 consecutive patients with preserved EF and aged >60 years who underwent non-cardiac surgery, serum levels of hs-cTnT were measured before and on postoperative days 1 and 3 after surgery. PMI was defined as postoperative hs-cTnT >0.014 ng/mL and relative hs-cTnT change ≥20%. A total of 36 (23.8%) of the patients were diagnosed as having PMI. The incidence of a composite of cardiovascular events within 30 days after surgery, including myocardial infarction, stroke, worsening heart failure, atrial fibrillation and pulmonary embolism, was significantly higher in patients with PMI than in patients without PMI (odds ratio (OR) 9.25, P<0.001, 95% confidence interval (CI) 2.65-32.3). Multivariate analysis revealed that left ventricular diastolic dysfunction defined by echocardiography was independently associated with PMI (OR: 3.029, 95% CI: 1.341-6.84, P=0.008). CONCLUSIONS: PMI is frequently observed in elderly patients undergoing non-cardiac surgery. Diastolic dysfunction is an independent predictor of PMI.

DOI： 10.1253/circj.CJ-17-0747

Associations between intraoperative ventilator settings during one-lung ventilation and postoperative pulmonary complications: a prospective observational study. Reviewed International journal

Shuji Okahara, Kazuyoshi Shimizu, Satoshi Suzuki, Kenzo Ishii, Hiroshi Morimatsu

BMC anesthesiology 18 ( 1 ) 13 - 13 2018.1

Language：English Publishing type：Research paper (scientific journal)

BACKGROUND: The interest in perioperative lung protective ventilation has been increasing. However, optimal management during one-lung ventilation (OLV) remains undetermined, which not only includes tidal volume (VT) and positive end-expiratory pressure (PEEP) but also inspired oxygen fraction (FIO2). We aimed to investigate current practice of intraoperative ventilation during OLV, and analyze whether the intraoperative ventilator settings are associated with postoperative pulmonary complications (PPCs) after thoracic surgery. METHODS: We performed a prospective observational two-center study in Japan. Patients scheduled for thoracic surgery with OLV from April to October 2014 were eligible. We recorded ventilator settings (FIO2, VT, driving pressure (ΔP), and PEEP) and calculated the time-weighted average (TWA) of ventilator settings for the first 2 h of OLV. PPCs occurring within 7 days of thoracotomy were investigated. Associations between ventilator settings and the incidence of PPCs were examined by multivariate logistic regression. RESULTS: We analyzed perioperative information, including preoperative characteristics, ventilator settings, and details of surgery and anesthesia in 197 patients. Pressure control ventilation was utilized in most cases (92%). As an initial setting for OLV, an FIO2 of 1.0 was selected for more than 60% of all patients. Throughout OLV, the median TWA FIO2 of 0.8 (0.65-0.94), VT of 6.1 (5.3-7.0) ml/kg, ΔP of 17 (15-20) cm H2O, and PEEP of 4 (4-5) cm H2O was applied. Incidence rate of PPCs was 25.9%, and FIO2 was independently associated with the occurrence of PPCs in multivariate logistic regression. The adjusted odds ratio per FIO2 increase of 0.1 was 1.30 (95% confidence interval: 1.04-1.65, P = 0.0195). CONCLUSIONS: High FIO2 was applied to the majority of patients during OLV, whereas low VT and slight degree of PEEP were commonly used in our survey. Our findings suggested that a higher FIO2 during OLV could be associated with increased incidence of PPCs.

DOI： 10.1186/s12871-018-0476-x

Incidence of pulmonary complications with the prophylactic use of high-flow nasal cannula after pediatric cardiac surgery: Prophylactic HFNC study protocol Reviewed

Naohiro Shioji, Tomoyuki Kanazawa, Tatsuo Iwasaki, Kazuyoshi Shimizu, Tomohiko Suemori, Hirokazu Kawase, Satoshi Kimura, Yasutoshi Kuroe, Hiroshi Morimatsu

Acta Medica Okayama 72 ( 2 ) 193 - 196 2018

Language：English Publishing type：Research paper (scientific journal) Publisher：Okayama University

We will investigate the incidence of postoperative pulmonary complications (PPCs) with the prophylactic use of a high-flow nasal cannula (HFNC) after pediatric cardiac surgery. Children &lt
48 months old with congenital heart disease for whom cardiac surgery is planned will be included. The HFNC procedure will be commenced just after extubation, at a flow rate of 2 L/kg/min with adequate oxygen concentration to achieve target oxygen saturation ≥ 94%. This study will reveal the prevalence of PPCs after pediatric cardiac surgery with the prophylactic use of HFNC.

Severe Acute Respiratory Distress Syndrome Using Electrical Activity of the Diaphragm on Weaning from Extracorporeal Membrane Oxygenation. Reviewed

Shuji Okahara, Kazuyoshi Shimizu, Hiroshi Morimatsu

Acta medica Okayama 71 ( 6 ) 543 - 546 2017.12

Language：English

The electrical activity of the diaphragm (EAdi) shows global diaphragmatic activation and power output from the central nervous system. We measured the EAdi as an indicator of breathing workload in a 40-year-old man suffering from severe acute respiratory distress syndrome (ARDS) secondary to influenza pneumonia in the process of weaning from extracorporeal membrane oxygenation (ECMO). Turning off the sweep gas flow immediately led to EAdi elevation, followed by hypoxia. The patient was successfully weaned from ECMO by reference to EAdi. This is the first case report to suggest that EAdi monitoring might be useful for ARDS patients during ECMO weaning.

DOI： 10.18926/AMO/55593

Perioperative Brain Natriuretic Peptide in Pediatric Cardiac Surgery Patients: Its Association With Postoperative Outcomes. Reviewed International journal

Tomoyuki Kanazawa, Moritoki Egi, Yuichiro Toda, Kazuyoshi Shimizu, Kentaro Sugimoto, Tatsuo Iwasaki, Hiroshi Morimatsu

Journal of cardiothoracic and vascular anesthesia 31 ( 2 ) 537 - 542 2017.4

Language：English Publishing type：Research paper (scientific journal)

OBJECTIVES: The aim of this study was to investigate the relationship between perioperative brain natriuretic peptide levels and the incidence of postoperative serious adverse events (SAEs) in pediatric cardiac patients. DESIGN: A prospective observational study. SETTING: A single-institution university hospital. PARTICIPANTS: Children under 15 years old who underwent cardiac surgery that required cardiopulmonary bypass from December 21, 2012 to February 26, 2014. The Risk Adjustment for Congenital Heart Surgery 1 category less than 1 was excluded. INTERVENTIONS: Brain natriuretic peptide (BNP) levels were measured preoperatively (BNPpre) and on postoperative day 1 (BNPPOD1) and postoperative day 3 (BNPPOD3). METHODS AND RESULTS: Primary outcome was the incidence of postoperative SAEs; (1) death in the intensive care unit, (2) requirement of extracorporeal membrane oxygenation, (3) cardiac arrest, and (4) requirement of reoperation for hemodynamic instability. The authors included 71 patients in this study. There were 8 patients (11%) who had at least 1 SAE. Median preoperative BNP level in patients with SAEs was significantly higher than in those without SAEs (1,541 pg/mL [IQR: 121-5,962] v 122 pg/mL [QR: 34-342], p = 0.01). From the receiver operating characteristic curve of BNPpre for the incidence of SAEs, an area under the curve was 0.77 (95%CI 0.55-0.91). The best cutoff BNPpre number was 1,000 pg/mL. From the multivariate logistic regression model, BNPpre>1,000 pg/mL was associated independently with risk of SAEs (adjusted odds ratio = 8.5, 95% CI [1.3, 59.3], p = 0.02). CONCLUSIONS: In conclusion, the authors' study showed that increased preoperative brain natriuretic peptide concentration, especially a concentration of more than 1,000 pg/mL, was associated with risk of SAEs in pediatric cardiac surgery patients.

DOI： 10.1053/j.jvca.2016.09.008

ガムエラスティックブジー使用下気管切開チューブ挿入時に気管膜様部裂創に至った症例 Reviewed

内藤真由, 伊加真士, 黒江泰利, 清水一好, 武田吉正, 森松博史

日本臨床麻酔学会誌 37 ( 2 ) 156 - 161 2017.3

Language：Japanese Publisher：日本臨床麻酔学会

89歳,女性.口腔癌に対し全身麻酔下に切除術が予定された.気管挿管後,気管切開を施行し,気切孔よりガムエラスティックブジー(GEB)に沿ってスパイラルチューブを挿入した.両者とも抵抗なく挿入できたが,ETCO2は検出されなかった.気管支鏡で確認したところ,気管膜様部裂創を認めた.直ちに右片肺挿管とし,次いで左片肺挿管にした後に,開胸による気管修復術が施行された.この間,SpO2は100%を維持でき,循環動態も安定していた.術後は挿管のまま集中治療室へ入室,術後5日目に人工呼吸器から離脱,7日目にICU退室となった.気管切開手技のチューブ挿入時のGEBのルーチン使用を見直し,症例ごとの必要性などを術者と検討するべきである.(著者抄録)

Other Link： https://search.jamas.or.jp/default/link?pub_year=2017&ichushi_jid=J01620&link_issn=&doc_id=20170321180003&doc_link_id=%2Fci4jjsca%2F2017%2F003702%2F003%2F0156-0161%26dl%3D0&url=https%3A%2F%2Fwww.medicalonline.jp%2Fjamas.php%3FGoodsID%3D%2Fci4jjsca%2F2017%2F003702%2F003%2F0156-0161%26dl%3D0&type=MedicalOnline&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00004_2.gif

高トリグリセリド血症起因性急性膵炎にLDL(low density lipoprotein)吸着療法が奏功した妊婦の1例 Reviewed

佐倉考信, 清水一好, 廣井一正, 鈴木聡, 林真雄, 賀来隆治, 森松博史

日本集中治療医学会雑誌 24 ( 1 ) 26 - 30 2017.1

Language：Japanese Publisher：(一社)日本集中治療医学会

妊娠中の急性膵炎は稀な疾患であるが、発症すると母体、胎児ともに予後が悪い。著明な高トリグリセリド(triglyceride、TG)血症による急性膵炎を発症した妊婦に対して、LDL(low density lipoprotein)吸着療法を施行し良好な経過をたどった症例を経験した。症例は35歳、妊娠39週の女性。TG 11,936mg/dlの著明な高TG血症を認め、造影CTにて重症急性膵炎を疑う所見を認めた。帝王切開にて妊娠を中断の後、ICU入室となり急性膵炎、高TG血症に対する治療を開始した。高TG血症に対してLDL吸着療法を3回施行し、TG値は1,764mg/dlまで低下した。その後、膵炎に対する保存加療が継続され、第15病日に退院した。高TG血症起因性急性膵炎において、高TG血症の治療併用は重要である。本疾患を合併した妊婦に対して、血漿交換と比較して合併症頻度の低いLDL吸着療法を選択し、安全に施行できた。(著者抄録)

Physiological impact of high-flow nasal cannula therapy on postextubation acute respiratory failure after pediatric cardiac surgery: a prospective observational study. Reviewed International journal

Naohiro Shioji, Tatsuo Iwasaki, Tomoyuki Kanazawa, Kazuyoshi Shimizu, Tomohiko Suemori, Kentaro Sugimoto, Yasutoshi Kuroe, Hiroshi Morimatsu

Journal of intensive care 5 35 - 35 2017

Language：English Publishing type：Research paper (scientific journal)

BACKGROUND: Reintubation after pediatric cardiac surgery is associated with a high rate of mortality. Therefore, adequate respiratory support for postextubation acute respiratory failure (ARF) is important. However, little is known about the physiological impact of high-flow nasal cannula (HFNC) therapy on ARF after pediatric cardiac surgery. Our working hypothesis was that HFNC therapy for postextubation ARF after pediatric cardiac surgery improves hemodynamic and respiratory parameters. METHODS: This was a prospective observational study conducted at a single university hospital. Children less than 48 months of age who had postextubation ARF after cardiac surgery were included in this study. HFNC therapy was started immediately after diagnosis of postextubation ARF. Data obtained just before starting HFNC therapy were used for pre-HFNC analysis, and data obtained 1 h after starting HFNC therapy were used for post-HFNC analysis. We compared hemodynamic and respiratory parameters between pre-HFNC and post-HFNC periods. The Wilcoxon signed-rank test was used to analyze these indices. RESULTS: Twenty children were included in this study. The median age and body weight were 4.5 (2.3-14.0) months and 4.3 (3.1-7.1) kg, respectively. Respiratory rate (RR) significantly decreased from 43.5 (32.0-54.8) to 28.5 (21.0-40.5) breaths per minute (p = 0.0008) 1 h after the start of HFNC therapy. Systolic blood pressure also decreased from 87.5 (77.8-103.5) to 76.0 (70.3-85.0) mmHg (p = 0.003). Oxygen saturation, partial pressure of arterial carbon dioxide, heart rate, and lactate showed no remarkable changes. There was no adverse event caused by HFNC therapy. CONCLUSIONS: HFNC therapy improves the RR of patients who have postextubation ARF after pediatric cardiac surgery without any adverse events.

DOI： 10.1186/s40560-017-0226-z

脊髄腫瘍摘出術後に頭蓋内出血、気脳症を発症した1症例 Reviewed

合田慶介, 小畑ダニエル, 金澤伴幸, 三好亜希子, 佐々木俊弘, 末盛智彦, 清水一好, 森松博史

麻酔 65 ( 12 ) 1271 - 1275 2016.12

Language：Japanese Publisher：克誠堂出版(株)

75歳女性。第3・4腰椎レベルの硬膜内髄外腫瘍に対し腫瘍摘出術が予定された。レミフェンタニル、プロポフォールによる麻酔管理を行い、術中の血圧変動にはフェニレフリン、ニカルジピンを使用し、手術は終了した。麻酔終了後の覚醒遅延を契機に頭蓋内出血、気脳症を発症したが、対症療法を主体とした全身管理を行ったところ、術後1日目のCTで気脳症や頭蓋内出血の改善が確認された。その後、徐々に意識レベルは改善し、軽度の認知機能障害が残存したものの、術後22日目に転院となった。

レボチロキシン内服中止により気管切開後気管狭窄が増悪した慢性甲状腺炎の1例 Reviewed

名原功, 清水一好, 片山明, 川出健嗣, 日笠友起子, 林真雄, 松岡義和, 森松博史

ICUとCCU 40 ( 9 ) 653 - 657 2016.9

Language：Japanese Publisher：医学図書出版(株)

慢性甲状腺炎(橋本病)は自己免疫性疾患であり、びまん性の甲状腺腫大を呈する。橋本病に対する治療薬中断により、気管切開部の気道狭窄が顕性化した症例を経験したので報告する。症例は57歳男性で、2年前に気管切開の既往があり、4ヵ月前にレボチロキシンの内服により気道狭窄が改善したエピソードがあった。今回は呼吸困難により受診し、頸部CTにて著明な気管狭窄を認め挿管管理となった。気管切開部の狭窄を浮腫や甲状腺腫大が助長させたと考え、利尿による水分管理に加え、レボチロキシンの内服を再開し気道管理を施行した。第6病日に気管狭窄は入室時より改善し抜管に至った。気管切開の既往がある慢性甲状腺炎を有する症例において、甲状腺ホルモン補充中断は甲状腺腫大増悪により気管狭窄を重症化させる危険性が高い。また、侵襲的気道管理を回避するために、甲状腺ホルモンの内服薬開を含めた内科的な集学的治療をまずは考慮すべきである。(著者抄録)

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コントロール不良の肺動脈性肺高血圧症に合併した急性肺動脈解離の一例 Reviewed

川出健嗣, 清水一好, 林真雄, 谷真規子, 鈴木聡, 金澤伴幸, 岩崎達雄, 森松博史

日本集中治療医学会雑誌 23 ( 3 ) 318 - 323 2016.5

Language：Japanese Publisher：(一社)日本集中治療医学会

症例は29歳、男性。5年前に肺動脈性肺高血圧症(pulmonary arterial hypertension、PAH)を指摘されたが、内科的治療は行われていなかった。今回、胸痛を主訴に近医を受診し、造影CTにて肺動脈解離(pulmonary artery dissection、PAD)を指摘されたため、当院へ転院となった。当院入院後、緊急で主肺動脈人工血管置換術および左右肺動脈縫縮術が施行された。術後、PAHに対して早期に治療を開始した。未治療であったためPAHのコントロールに難渋したが、PAH治療薬の多剤併用および厳重な鎮静・挿管・人工呼吸管理を行うことで、POD21に抜管、POD29にICUを退室、POD101に退院となった。PADは非常に致死率の高い疾患であるが、早期の手術および厳重な術後管理により救命できた。(著者抄録)

Other Link： https://search.jamas.or.jp/default/link?pub_year=2016&ichushi_jid=J02874&link_issn=&doc_id=20160610390006&doc_link_id=10.3918%2Fjsicm.23.318&url=https%3A%2F%2Fdoi.org%2F10.3918%2Fjsicm.23.318&type=J-STAGE&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00007_3.gif

Storage duration of transfused red blood cells is not significantly associated with postoperative adverse events in pediatric cardiac surgery patients. Reviewed International journal

Hirokazu Kawase, Moritoki Egi, Tomoyuki Kanazawa, Kazuyoshi Shimizu, Yuichiro Toda, Tatsuo Iwasaki, Kiyoshi Morita

Transfusion and apheresis science : official journal of the World Apheresis Association : official journal of the European Society for Haemapheresis 54 ( 1 ) 111 - 6 2016.2

Language：English Publishing type：Research paper (scientific journal)

The aim of this study was to evaluate the association of storage duration of transfused red blood cells with the risk of postoperative serious adverse events in pediatric cardiac surgery patients. We studied 517 patients and found that 22 patients (4.3%) had at least one serious adverse event. The maximum and mean storage duration of transfused red blood cells did not differ significantly between patients with and without serious adverse events (maximum, p = 0.89; mean, p = 0.81). In our study of pediatric cardiac surgery patients, the storage duration of transfused red blood cells was not significantly associated with the risk of serious adverse events.

DOI： 10.1016/j.transci.2016.01.027

Urinary Albumin Levels Predict Development of Acute Kidney Injury After Pediatric Cardiac Surgery: A Prospective Observational Study. Reviewed International journal

Kentaro Sugimoto, Yuichiro Toda, Tatsuo Iwasaki, Kazuyoshi Shimizu, Tomoyuki Kanazawa, Noriko Muto, Hirokazu Kawase, Hiroshi Morimatsu, Kiyoshi Morita, Yohei Maeshima, Kiyoshi Mori, Shunji Sano

Journal of cardiothoracic and vascular anesthesia 30 ( 1 ) 64 - 8 2016.1

Language：English Publishing type：Research paper (scientific journal)

OBJECTIVE: Mortality and morbidity of acute kidney injury (AKI) after cardiac surgery still remain high. The authors undertook the present study to evaluate the utility of early postoperative urinary albumin (uAlb) as a diagnostic marker for predicting occurrence of AKI and its severity in pediatric patients undergoing cardiac surgery. DESIGN: A prospective observational study. SETTING: A single-institution university hospital. PARTICIPANTS: All patients<18 years of age who underwent repair of congenital heart disease with cardiopulmonary bypass between July 2010 and July 2012 were included in the study. Neonates age<1 month were excluded from the study population. INTERVENTIONS: The association between uAlb and occurrence of AKI within 3 days after admission to the intensive care unit was investigated. Criteria from pediatric-modified Risk Injury Failure Loss and End-stage kidney disease (pRIFLE) were used to determine the occurrence of AKI. The value of uAlb was measured at intensive care unit admission immediately after cardiac surgery in all participants from whom a 5-mL urine sample was obtained. MEASUREMENTS AND MAIN RESULTS: Of 376 patients, AKI assessed by pRIFLE was identified in 243 (64.6%): 172 for risk (R; 45.7%), 44 for injury (I; 11.7%), and 27 for failure (F; 7.2%). One hundred thirty-three patients (35.4%) were classified as being without AKI (normal [N]) by pRIFLE. The concentration of uAlb was significantly higher in AKI patients than in non-AKI patients (median [interquartile range]): uAlb (µg/mL): 13.5 (6.4-39.6) v 6.0 (3.4-16), p<0.001; uAlb/Cr (mg/gCr): 325 (138-760) v 121 (53-269), p< 0.001. CONCLUSIONS: The utility of uAlb for prompt diagnosis of AKI was shown. Obtaining uAlb measurements early after pediatric cardiac surgery may be useful for predicting the occurrence and severity of AKI.

DOI： 10.1053/j.jvca.2015.05.194

スガマデクス投与後ロクロニウムの再クラーレ化が疑われた1症例 Reviewed

伊加真士, 清水一好, 川出健嗣, 金澤伴幸, 西谷恭子, 森松博史

日本臨床麻酔学会誌 36 ( 1 ) 1 - 6 2016.1

Language：Japanese Publisher：日本臨床麻酔学会

スガマデクスは安全・迅速にロクロニウムを拮抗できる薬剤として広く使用されている.今回われわれは筋弛緩モニターを使用し,投与基準どおりにスガマデクスを使用したにもかかわらず,術後に再クラーレ化が疑われた症例を経験した.症例は78歳の男性で,胃癌に対し腹腔鏡下幽門側胃切除術が施行された.術中およびスガマデクス投与前にTOFウォッチを使用し,TOFカウント2を確認後,スガマデクスを3.6mg/kg投与し抜管した.その約70分後に著明な酸素化の悪化と四肢の体動低下を認め,ネオスチグミン投与により酸素化・体動の改善を得た.投与基準どおりのスガマデクス使用でも再クラーレ化の可能性は否定できないため,抜管後の厳重な呼吸の観察が重要である.(著者抄録)

Other Link： https://search.jamas.or.jp/default/link?pub_year=2016&ichushi_jid=J01620&link_issn=&doc_id=20160128310001&doc_link_id=%2Fci4jjsca%2F2016%2F003601%2F001%2F0001-0006%26dl%3D0&url=https%3A%2F%2Fwww.medicalonline.jp%2Fjamas.php%3FGoodsID%3D%2Fci4jjsca%2F2016%2F003601%2F001%2F0001-0006%26dl%3D0&type=MedicalOnline&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00004_2.gif

上顎癌術直後にAeromonas属による治療抵抗性の敗血症性ショックをきたし、急激な経過をたどった症例 Reviewed

塩路直弘, 清水一好, 林真雄, 金澤伴幸, 鈴木聡, 岡原修司, 日笠友起子, 森松博史

ICUとCCU 39 ( 7 ) 431 - 435 2015.7

Language：Japanese Publisher：医学図書出版(株)

症例は71歳、男性。上顎癌に対して放射線、化学療法を先行した後、根治術を施行した。術後ICUに予定入室したが、入室約6時間後から血圧低下、代謝性アシドーシスが出現した。輸液負荷とノルアドレナリン持続投与にも抵抗性で敗血症性ショックを疑い、抗菌薬を変更、バソプレシン、アドレナリン、ハイドロコルチゾンを追加、CHDFを開始した。入室2日目に血液培養でグラム陰性桿菌が陽性となった。循環・呼吸不全と肝不全が進行したため、血漿交換、VA ECMOを導入した。その後も左心不全が急速に進行しIABPも挿入した。経過中2度、開創し皮弁を確認したが皮弁の血流は保たれていた。あらゆる治療に反応なく入室4日目に永眠した。後日、血液培養の結果がAeromonas属であることが判明した。免疫抑制の背景をもつ患者の場合、Aeromonas属による敗血症性ショックは重篤化し、急激に進行する可能性がある。(著者抄録)

Other Link： https://search.jamas.or.jp/default/link?pub_year=2015&ichushi_jid=J00001&link_issn=&doc_id=20150811310006&doc_link_id=%2Faa6icutc%2F2015%2F003907%2F007%2F0431-0435%26dl%3D0&url=https%3A%2F%2Fwww.medicalonline.jp%2Fjamas.php%3FGoodsID%3D%2Faa6icutc%2F2015%2F003907%2F007%2F0431-0435%26dl%3D0&type=MedicalOnline&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00004_2.gif

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