Faculty Profiles - SUZUKI Satoshi

Papers - SUZUKI Satoshi

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Oxygen administration for postoperative surgical patients: a narrative review. Invited Reviewed International journal

Satoshi Suzuki

Journal of intensive care 8 79 - 79 2020

Authorship：Lead author,　Corresponding author Language：English Publishing type：Research paper (scientific journal)

Most postoperative surgical patients routinely receive supplemental oxygen therapy to prevent the potential development of hypoxemia due to incomplete lung re-expansion, reduced chest wall, and diaphragmatic activity caused by surgical site pain, consequences of hemodynamic impairment, and residual effects of anesthetic drugs (most notably residual neuromuscular blockade), which may result in atelectasis, ventilation-perfusion mismatch, alveolar hypoventilation, and impaired upper airway patency. Additionally, the World Health Organization guidelines for reducing surgical site infection have recommended the perioperative administration of high-dose oxygen, including during the immediate postoperative period. However, supplemental oxygen and hyperoxemia also have harmful effects on the respiratory and cardiovascular systems, with several clinical studies having reported an association between high perioperative oxygen administration and worse clinical outcomes. Recently, the increased availability of new and short-acting anesthetic drugs, comprehensive pharmacological knowledge, postoperative multimodal analgesia, and new minimally invasive surgery options could result in lower incidences of postoperative hypoxemia. Moreover, recommendations promoting high oxygen administration to prevent surgical site infections have been challenged, considering the lack of scientific investigations, and have not been widely accepted. Given the potential harmful effects of hyperoxemia, routine postoperative oxygen administration might not be recommended. Recent clinical studies have indicated that a conservative approach to oxygen therapy, where oxygen administration is titrated to achieve slightly lower oxygen levels than usual, could be safely implemented and decrease acutely ill patients' susceptibility to hyperoxemia. Based on current evidence, appropriate monitoring, including peripheral oxygen saturation, and oxygen titration should be required during postoperative oxygen administration to avoid both hypoxemia and hyperoxemia. Future trials should therefore focus on determining the optimal oxygen target during postoperative care.

DOI： 10.1186/s40560-020-00498-5

Current Ventilator and Oxygen Management during General Anesthesia: A Multicenter, Cross-sectional Observational Study. Reviewed International journal

Satoshi Suzuki, Yuko Mihara, Yukiko Hikasa, Shuji Okahara, Takuma Ishihara, Ayumi Shintani, Hiroshi Morimatsu, Akiko Sato, Sachio Kusume, Hidekuni Hidaka, Hidehiko Yatsuzuka, Masahiro Okawa, Makoto Takatori, Shinsei Saeki, Takeshi Samuta, Hiroaki Tokioka, Toshiaki Kurasako, Masato Maeda, Mamoru Takeuchi, Akihito Hirasaki, Michio Kitaura, Hideki Kajiki, Osamu Kobayashi, Hiroshi Katayama, Hideki Nakatsuka, Satoshi Mizobuchi, Seiji Sugimoto, Masataka Yokoyama, Kazuhito Kusudo, Kensuke Shiraishi, Toshio Iwaki, Tatsuhiko Komatsu, Yasuo Hirai, Tetsufumi Sato, Masakazu Kimura, Takeshi Yasukawa, Motonobu Kimura, Masahiro Taniguchi, Yutaka Shimoda, Yoji Kobayashi, Mitsunori Tsukioki, Nobuki Manabe, Eiji Ando, Makoto Kosaka, Takashi Tsukiji, Chika Tokura, Yasuhiro Asao, Masatoshi Sugiyama, Kozo Seto

Anesthesiology 129 ( 1 ) 67 - 76 2018.7

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

BACKGROUND: Intraoperative oxygen management is poorly understood. It was hypothesized that potentially preventable hyperoxemia and substantial oxygen exposure would be common during general anesthesia. METHODS: A multicenter, cross-sectional study was conducted to describe current ventilator management, particularly oxygen management, during general anesthesia in Japan. All adult patients (16 yr old or older) who received general anesthesia over 5 consecutive days in 2015 at 43 participating hospitals were identified. Ventilator settings and vital signs were collected 1 h after the induction of general anesthesia. We determined the prevalence of potentially preventable hyperoxemia (oxygen saturation measured by pulse oximetry of more than 98%, despite fractional inspired oxygen tension of more than 0.21) and the risk factors for potentially substantial oxygen exposure (fractional inspired oxygen tension of more than 0.5, despite oxygen saturation measured by pulse oximetry of more than 92%). RESULTS: A total of 1,786 patients were found eligible, and 1,498 completed the study. Fractional inspired oxygen tension was between 0.31 and 0.6 in 1,385 patients (92%), whereas it was less than or equal to 0.3 in very few patients (1%). Most patients (83%) were exposed to potentially preventable hyperoxemia, and 32% had potentially substantial oxygen exposure. In multivariable analysis, old age, emergency surgery, and one-lung ventilation were independently associated with increased potentially substantial oxygen exposure, whereas use of volume control ventilation and high positive end-expiratory pressure levels were associated with decreased potentially substantial oxygen exposure. One-lung ventilation was particularly a strong risk factor for potentially substantial oxygen exposure (adjusted odds ratio, 13.35; 95% CI, 7.24 to 24.60). CONCLUSIONS: Potentially preventable hyperoxemia and substantial oxygen exposure are common during general anesthesia, especially during one-lung ventilation. Future research should explore the safety and feasibility of a more conservative approach for intraoperative oxygen therapy.

DOI： 10.1097/ALN.0000000000002181

術後呼吸器合併症を防ぐ Invited Reviewed

鈴木聡

臨床麻酔 48 ( 9 ) 1019 - 1027 2024.9

イソフルラン,プロポフォールを投与し鎮静薬を計画的に減量しえた長期人工呼吸管理の小児重症心不全例 Reviewed

成谷俊輝, 黒田浩佐, 岡原修司, 鈴木聡, 金澤伴幸, 清水一好, 岩崎達雄, 森松博史

日本集中治療医学会雑誌 31 ( 4 ) 261 - 265 2024.7

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

小児の長期にわたる鎮静は,薬剤耐性や医原性離脱症候群(iatrogenic withdrawal syndrome,IWS)を引き起こし,管理に難渋する場合がある。患者は14歳,男児。劇症型心筋炎と診断され左心補助人工心臓を必要とし,鎮痛鎮静薬は高用量かつ長期間投与となった。抜管に向けてIWS発症回避のため薬剤漸減の必要があったが,その過程での安全な管理のために抜管までは鎮静度の維持が必要と考えた。ミダゾラムとフェンタニルは12時間ごとに5%ずつ減量し,その間は適応外使用としてケタミン,イソフルラン,プロポフォールを順に投与し,鎮静度を維持した。プロポフォール中止後は速やかに覚醒が得られたため抜管し,ミダゾラム,フェンタニル中止後にデクスメデトミジンを漸減終了した。経過中はプロポフォール注入症候群,IWS,悪性高熱症を疑う所見を認めなかった。(著者抄録)

Other Link： https://search.jamas.or.jp/default/link?pub_year=2024&ichushi_jid=J02874&link_issn=&doc_id=20240719470006&doc_link_id=20240719470001&url=http%3A%2F%2Fsearch.jamas.or.jp%2Flink%2Fbc%2F20240719470001&type=jamaslink&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F99999_1.gif

Stroke volume variation and dynamic arterial elastance predict fluid responsiveness even in thoracoscopic esophagectomy: a prospective observational study Reviewed

Yukiko Hikasa, Satoshi Suzuki, Shunsuke Tanabe, Kazuhiro Noma, Yasuhiro Shirakawa, Toshiyoshi Fujiwara, Hiroshi Morimatsu

Journal of Anesthesia 37 ( 6 ) 930 - 937 2023.9

Prolonged Double-Low Time and the Incidence of Postoperative Delirium in Surgical ICU Patients Reviewed

Yamanoi T, Suzuki S, Kaku R, Morimatsu H

Acta Med Okayama 77 ( 2 ) 161 - 167 2023.4

Consistently low levels of histidine-rich glycoprotein as a new prognostic biomarker for sepsis: A multicenter prospective observational study Reviewed

Naoya Kawanoue, Kosuke Kuroda, Hiroko Yasuda, Masahiko Oiwa, Satoshi Suzuki, Hidenori Wake, Hiroki Hosoi, Masahiro Nishibori, Hiroshi Morimatsu

PLOS ONE 18 ( 3 ) e0283426 - e0283426 2023.3

Language：English Publishing type：Research paper (scientific journal) Publisher：Public Library of Science (PLoS)

Background

Few sepsis biomarkers accurately predict severity and mortality. Previously, we had reported that first-day histidine-rich glycoprotein (HRG) levels were significantly lower in patients with sepsis and were associated with mortality. Since the time trends of HRG are unknown, this study focused on the time course of HRG in patients with sepsis and evaluated the differences between survivors and non-survivors.

Methods

A multicenter prospective observational study was conducted involving 200 patients with sepsis in 16 Japanese hospitals. Blood samples were collected on days 1, 3, 5, and 7, and 28-day mortality was used for survival analysis. Plasma HRG levels were determined using a modified quantitative sandwich enzyme-linked immunosorbent assay.

Results

First-day HRG levels in non-survivors were significantly lower than those in survivors (mean, 15.7 [95% confidence interval (CI), 13.4–18.1] vs 20.7 [19.5–21.9] μg/mL; P = 0.006). Although there was no time × survivors/non-survivors interaction in the time courses of HRG (P = 0.34), the main effect of generalized linear mixed models was significant (P < 0.001). In a univariate Cox proportional hazards model with each variable as a time-dependent covariate, higher HRG levels were significantly associated with a lower risk of mortality (hazard ratio, 0.85 [95% CI, 0.78–0.92]; P < 0.001). Furthermore, presepsin levels (P = 0.02) and Sequential Organ Function Assessment scores (P < 0.001) were significantly associated with mortality. Harrell’s C-index values for the 28-day mortality effect of HRG, presepsin, procalcitonin, and C-reactive protein were 0.72, 0.70, 0.63, and 0.59, respectively.

Conclusions

HRG levels in non-survivors were consistently lower than those in survivors during the first seven days of sepsis. Repeatedly measured HRG levels were significantly associated with mortality. Furthermore, the predictive power of HRG for mortality may be superior to that of other singular biomarkers, including presepsin, procalcitonin, and C-reactive protein.

DOI： 10.1371/journal.pone.0283426

周術期酸素投与，周術期体温管理と術後予後（手術部位感染を中心に） Invited Reviewed

鈴木聡

麻酔 70 ( 9 ) 945 - 950 2021.9

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

Moritoki Egi, Hiroshi Ogura, Tomoaki Yatabe, Kazuaki Atagi, Shigeaki Inoue, Toshiaki Iba, Yasuyuki Kakihana, Tatsuya Kawasaki, Shigeki Kushimoto, Yasuhiro Kuroda, Joji Kotani, Nobuaki Shime, Takumi Taniguchi, Ryosuke Tsuruta, Kent Doi, Matsuyuki Doi, Taka-Aki Nakada, Masaki Nakane, Seitaro Fujishima, Naoto Hosokawa, Yoshiki Masuda, Asako Matsushima, Naoyuki Matsuda, Kazuma Yamakawa, Yoshitaka Hara, Masaaki Sakuraya, Shinichiro Ohshimo, Yoshitaka Aoki, Mai Inada, Yutaka Umemura, Yusuke Kawai, Yutaka Kondo, Hiroki Saito, Shunsuke Taito, Chikashi Takeda, Takero Terayama, Hideo Tohira, Hideki Hashimoto, Kei Hayashida, Toru Hifumi, Tomoya Hirose, Tatsuma Fukuda, Tomoko Fujii, Shinya Miura, Hideto Yasuda, Toshikazu Abe, Kohkichi Andoh, Yuki Iida, Tadashi Ishihara, Kentaro Ide, Kenta Ito, Yusuke Ito, Yu Inata, Akemi Utsunomiya, Takeshi Unoki, Koji Endo, Akira Ouchi, Masayuki Ozaki, Satoshi Ono, Morihiro Katsura, Atsushi Kawaguchi, Yusuke Kawamura, Daisuke Kudo, Kenji Kubo, Kiyoyasu Kurahashi, Hideaki Sakuramoto, Akira Shimoyama, Takeshi Suzuki, Shusuke Sekine, Motohiro Sekino, Nozomi Takahashi, Sei Takahashi, Hiroshi Takahashi, Takashi Tagami, Goro Tajima, Hiroomi Tatsumi, Masanori Tani, Asuka Tsuchiya, Yusuke Tsutsumi, Takaki Naito, Masaharu Nagae, Ichiro Nagasawa, Kensuke Nakamura, Tetsuro Nishimura, Shin Nunomiya, Yasuhiro Norisue, Satoru Hashimoto, Daisuke Hasegawa, Junji Hatakeyama, Naoki Hara, Naoki Higashibeppu, Nana Furushima, Hirotaka Furusono, Yujiro Matsuishi, Tasuku Matsuyama, Yusuke Minematsu, Ryoichi Miyashita, Yuji Miyatake, Megumi Moriyasu, Toru Yamada, Hiroyuki Yamada, Ryo Yamamoto, Takeshi Yoshida, Yuhei Yoshida, Jumpei Yoshimura, Ryuichi Yotsumoto, Hiroshi Yonekura, Takeshi Wada, Eizo Watanabe, Makoto Aoki, Hideki Asai, Takakuni Abe, Yutaka Igarashi, Naoya Iguchi, Masami Ishikawa, Go Ishimaru, Shutaro Isokawa, Ryuta Itakura, Hisashi Imahase, Haruki Imura, Takashi Irinoda, Kenji Uehara, Noritaka Ushio, Takeshi Umegaki, Yuko Egawa, Yuki Enomoto, Kohei Ota, Yoshifumi Ohchi, Takanori Ohno, Hiroyuki Ohbe, Kazuyuki Oka, Nobunaga Okada, Yohei Okada, Hiromu Okano, Jun Okamoto, Hiroshi Okuda, Takayuki Ogura, Yu Onodera, Yuhta Oyama, Motoshi Kainuma, Eisuke Kako, Masahiro Kashiura, Hiromi Kato, Akihiro Kanaya, Tadashi Kaneko, Keita Kanehata, Ken-Ichi Kano, Hiroyuki Kawano, Kazuya Kikutani, Hitoshi Kikuchi, Takahiro Kido, Sho Kimura, Hiroyuki Koami, Daisuke Kobashi, Iwao Saiki, Masahito Sakai, Ayaka Sakamoto, Tetsuya Sato, Yasuhiro Shiga, Manabu Shimoto, Shinya Shimoyama, Tomohisa Shoko, Yoh Sugawara, Atsunori Sugita, Satoshi Suzuki, Yuji Suzuki, Tomohiro Suhara, Kenji Sonota, Shuhei Takauji, Kohei Takashima, Sho Takahashi, Yoko Takahashi, Jun Takeshita, Yuuki Tanaka, Akihito Tampo, Taichiro Tsunoyama, Kenichi Tetsuhara, Kentaro Tokunaga, Yoshihiro Tomioka, Kentaro Tomita, Naoki Tominaga, Mitsunobu Toyosaki, Yukitoshi Toyoda, Hiromichi Naito, Isao Nagata, Tadashi Nagato, Yoshimi Nakamura, Yuki Nakamori, Isao Nahara, Hiromu Naraba, Chihiro Narita, Norihiro Nishioka, Tomoya Nishimura, Kei Nishiyama, Tomohisa Nomura, Taiki Haga, Yoshihiro Hagiwara, Katsuhiko Hashimoto, Takeshi Hatachi, Toshiaki Hamasaki, Takuya Hayashi, Minoru Hayashi, Atsuki Hayamizu, Go Haraguchi, Yohei Hirano, Ryo Fujii, Motoki Fujita, Naoyuki Fujimura, Hiraku Funakoshi, Masahito Horiguchi, Jun Maki, Naohisa Masunaga, Yosuke Matsumura, Takuya Mayumi, Keisuke Minami, Yuya Miyazaki, Kazuyuki Miyamoto, Teppei Murata, Machi Yanai, Takao Yano, Kohei Yamada, Naoki Yamada, Tomonori Yamamoto, Shodai Yoshihiro, Hiroshi Tanaka, Osamu Nishida

Journal of intensive care 9 ( 1 ) 53 - 53 2021.8

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

The Japanese Clinical Practice Guidelines for Management of Sepsis and Septic Shock 2020 (J-SSCG 2020), a Japanese-specific set of clinical practice guidelines for sepsis and septic shock created as revised from J-SSCG 2016 jointly by the Japanese Society of Intensive Care Medicine and the Japanese Association for Acute Medicine, was first released in September 2020 and published in February 2021. An English-language version of these guidelines was created based on the contents of the original Japanese-language version. The purpose of this guideline is to assist medical staff in making appropriate decisions to improve the prognosis of patients undergoing treatment for sepsis and septic shock. We aimed to provide high-quality guidelines that are easy to use and understand for specialists, general clinicians, and multidisciplinary medical professionals. J-SSCG 2016 took up new subjects that were not present in SSCG 2016 (e.g., ICU-acquired weakness [ICU-AW], post-intensive care syndrome [PICS], and body temperature management). The J-SSCG 2020 covered a total of 22 areas with four additional new areas (patient- and family-centered care, sepsis treatment system, neuro-intensive treatment, and stress ulcers). A total of 118 important clinical issues (clinical questions, CQs) were extracted regardless of the presence or absence of evidence. These CQs also include those that have been given particular focus within Japan. This is a large-scale guideline covering multiple fields; thus, in addition to the 25 committee members, we had the participation and support of a total of 226 members who are professionals (physicians, nurses, physiotherapists, clinical engineers, and pharmacists) and medical workers with a history of sepsis or critical illness. The GRADE method was adopted for making recommendations, and the modified Delphi method was used to determine recommendations by voting from all committee members.As a result, 79 GRADE-based recommendations, 5 Good Practice Statements (GPS), 18 expert consensuses, 27 answers to background questions (BQs), and summaries of definitions and diagnosis of sepsis were created as responses to 118 CQs. We also incorporated visual information for each CQ according to the time course of treatment, and we will also distribute this as an app. The J-SSCG 2020 is expected to be widely used as a useful bedside guideline in the field of sepsis treatment both in Japan and overseas involving multiple disciplines.

DOI： 10.1186/s40560-021-00555-7

Intraoperative fluid therapy and postoperative complications during minimally invasive esophagectomy for esophageal cancer: a single-center retrospective study. Reviewed

Yukiko Hikasa, Satoshi Suzuki, Yuko Mihara, Shunsuke Tanabe, Yasuhiro Shirakawa, Toshiyoshi Fujiwara, Hiroshi Morimatsu

Journal of anesthesia 34 ( 3 ) 404 - 412 2020.6

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

PURPOSE: Compared with open thoracotomy, minimally invasive esophagectomy (MIE) methods, such as transhiatal or thoracoscopic esophagectomy, likely have lower morbidity. However, the relationship between intraoperative fluid management and postoperative complications after MIE remains unclear. Thus, we investigated the association of cumulative intraoperative fluid balance and postoperative complications in patients undergoing MIE. METHODS: This single-center retrospective cohort study examined patients undergoing thoracoscopic esophagectomy for esophageal cancer in the prone position. Postoperative complications included pneumonia, arrhythmia, thrombotic events and acute kidney injury (AKI). We compared patients with higher and lower intraoperative fluid balance (higher and lower than the median). Multivariable logistic regression analyses were performed to estimate the odds ratio of intraoperative fluid balance status on the incidence of postoperative complications. RESULTS: In total, 135 patients were included in the study. Postoperative complications occurred in 43 (32%), including cardiac arrhythmia (n = 12, 9%), thrombosis (n = 20, 15%), pneumonia (n = 13, 10%), and AKI required hemodialysis (n = 1, 1%). Patients with a higher fluid balance had higher incidence of complications than those with a lower fluid balance (46% vs. 18%, p < 0.001). After adjusting for age, ASA-PS ≥ III, blood loss, and the use of radical surgery, the higher intraoperative fluid balance group was significantly and independently associated with postoperative complications (adjusted OR 5.31, 95% CI 2.26-13.6, p < 0.0001). CONCLUSIONS: In patients undergoing thoracoscopic esophagectomy in the prone position, a greater intraoperative positive fluid balance was independently associated with a higher incidence of complications.

DOI： 10.1007/s00540-020-02766-y

Prolonged Tachycardia with Higher Heart Rate Is Associated with Higher ICU and In-hospital Mortality. Reviewed

Hayashi M, Taniguchi A, Kaku R, Fujimoto S, Isoyama S, Manabe S, Yoshida T, Suzuki S, Shimizu K, Morimatsu H, Momota R

Acta medica Okayama 73 ( 2 ) 147 - 153 2019.4

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

Tachycardia is common in intensive care units (ICUs). It is unknown whether tachycardia or prolonged tachycardia affects patient outcomes. We investigated the association between tachycardia and mortality in critically ill patients. This retrospective cohort study's primary outcome was patient mortality in the ICU and the hospital. We stratified the patients (n=476) by heart rate (HR) as LowHR, MediumHR, and HighHR groups. We also stratified them by their durations of HR >100 (prolonged HR; tachycardia): MildT, ModerateT, and SevereT groups. We determined the six groups' mortality. The ICU mortality rates of the LowHR, MediumHR, and HighHR groups were 1.0%, 1.5%, and 7.9%, respectively; significantly higher in the HighHR vs. LowHR group. The in-hospital mortality rates of these groups were 1%, 4.5%, and 14.6%, respectively; significantly higher in the HighHR vs. LowHR group. The ICU mortality rates of the MildT, ModerateT, and SevereT groups were 0.9%, 5.6%, and 57.1%, respectively. The mortality of the HRT=0 (i.e., all HR ≤ 100) patients was 0%. The in-hospital mortality rates of the MildT, ModerateT, and SevereT groups were 1.8%, 16.7%, and 85.7%, respectively; that of the HRT=0 patients was 0.5%. Both higher HR and prolonged tachycardia were associated with poor outcomes.

DOI： 10.18926/AMO/56650

Conservative versus conventional oxygen therapy for cardiac surgical patients: A before-and-after study. Reviewed International coauthorship International journal

Glenn M Eastwood, Matthew J Chan, Leah Peck, Helen Young, Johan Mårtensson, Neil J Glassford, Hidetoshi Kagaya, Satoshi Suzuki, Sean Galvin, George Matalanis, Rinaldo Bellomo

Anaesthesia and intensive care 47 ( 2 ) 175 - 182 2019.3

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

Avoiding hypoxaemia is considered crucial in cardiac surgery patients admitted to the intensive care unit (ICU). However, avoiding hyperoxaemia may also be important. A conservative approach to oxygen therapy may reduce exposure to hyperoxaemia without increasing the risk of hypoxaemia. Using a before-and-after design, we evaluated the introduction of conservative oxygen therapy (target SpO2 88%-92% using the lowest FiO2) for cardiac surgical patients admitted to the ICU. We studied 9041 arterial blood gas (ABG) datasets: 4298 ABGs from 245 'conventional' and 4743 ABGs from 298 'conservative' oxygen therapy patients. During mechanical ventilation (MV) and while in the ICU, compared to the conventional group, conservative group patients had significantly lower FiO2 exposure and PaO2 values ( P < 0.001 for each). Accordingly, using the mean PaO2 during MV, more conservative group patients were classified as normoxaemic (226 versus 62 patients, P < 0.01), fewer as hyperoxaemic (66 versus 178 patients, P < 0.01) and no patient in either group as hypoxaemic or severely hypoxaemic. Moreover, more ABG samples were hyperoxaemic or severely hyperoxaemic during conventional treatment ( P < 0.001). Finally, there was no difference in ICU or hospital length of stay, ICU or hospital mortality or 30-day mortality between the groups. Our findings support the feasibility and physiological safety of conservative oxygen therapy in patients admitted to ICU after cardiac surgery.

DOI： 10.1177/0310057X19838753

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

Yoshida T, Shimizu K, Suzuki S, Matsuoka Y, Morimatsu H

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

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) Publisher：BioMed Central Ltd.

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

Is supplemental oxygen necessary for intraoperative lung protective ventilation?

Shuji Okahara, Satoshi Suzuki, Hiroshi Morimatsu

Pulmonary and Critical Care Medicine 3 ( 1 ) 2018

Successful application of LDL (low density lipoprotein) apheresis for a pregnant woman with hypertriglyceridemia-induced acute pancreatitis

Sakura Takanobu, Shimizu Kazuyoshi, Hiroi Kazumasa, Suzuki Satoshi, Hayashi Masao, Kaku Ryuji, Morimatsu Hiroshi

Nihon Shuchu Chiryo Igakukai zasshi 24 ( 1 ) 26 - 30 2017

Language：Japanese Publisher：The Japanese Society of Intensive Care Medicine

A 35-year-old pregnant woman was referred to our hospital with suspected acute pancreatitis at 39 weeks of gestation. On admission, serum triglyceride (TG) level was 11,936 mg/dl and abdominal dynamic CT revealed severe acute pancreatitis. In order to avoid further progression of hypertriglyceridemia and acute pancreatitis, a cesarean section was performed. We then performed low density lipoprotein (LDL) apheresis for the hypertriglyceridemia with consideration of safety. After three cycles of LDL apheresis, serum TG level declined to 1,764 mg/dl. On the 15th day of hospitalization, she was discharged from our hospital without any complications. Treatment of hypertriglyceridemia, including plasma apheresis and heparin-insulin therapy, is important in addition to treatment of acute pancreatitis to reduce the risk of exacerbation of acute pancreatitis in hypertriglyceridemia-induced acute pancreatitis (HIAP). LDL apheresis would be safer than plasma exchange in terms of electrolyte disturbance and transfusion-related complication. LDL apheresis might be effective for patients with HIAP.

DOI： 10.3918/jsicm.24_26

A Case of Refractory Systemic Capillary Leak Syndrome (Clarkson's Disease) during Pregnancy Reviewed

Yukiko Hikasa, Masao Hayashi, Satoshi Suzuki, Hiroshi Morimatsu

ACTA MEDICA OKAYAMA 70 ( 6 ) 497 - 501 2016.12

Language：English Publishing type：Research paper (scientific journal) Publisher：OKAYAMA UNIV MED SCHOOL

A 32-year-old woman, pregnant with twins, presented with a chief complaint of general fatigue. Her general condition had rapidly deteriorated since her last visit to the primary obstetrician; the patient was then referred to our hospital because of suspected fetal death. She underwent emergency cesarean section because fetal death had indeed occurred, and she was then admitted to the intensive care unit (ICU). On ICI: admission, she was found to he in shock. Laboratory analysis revealed extreme hemoconcentration and a low albumin level, and initially, septic shock with obstetric complications was suspected. However, because she did not respond to conventional therapy but instead, rapidly developed severe generalized edema, systemic capillary leak syndrome (SCLS) was diagnosed. The patient remained in shock for several days until undergoing plasma exchange (PE), despite some earlier empirical treatments. She eventually recovered from profound shock status and was discharged from the ICU without sequelae. Among potentially effective treatments, PE seemed to be the most reasonable choice for the treatment of her SCLS.

DOI： 10.18926/AMO/54814

Targeted therapeutic mild hypercapnia after cardiac arrest: A phase II multi-centre randomised controlled trial (the CCC trial) Reviewed

Glenn M. Eastwood, Antoine G. Schneider, Satoshi Suzuki, Leah Peck, Helen Young, Aiko Tanaka, Johan Martensson, Stephen Warrillow, Shay McGuinness, Rachael Parke, Eileen Gilder, Lianne Mccarthy, Pauline Galt, Gopal Taori, Suzanne Eliott, Tammy Lamac, Michael Bailey, Nerina Harley, Deborah Barge, Carol L. Hodgson, Maria Cristina Morganti-Kossmann, Alice Pebay, Alison Conquest, John S. Archer, Stephen Bernard, Dion Stub, Graeme K. Hart, Rinaldo Bellomo

RESUSCITATION 104 83 - 90 2016.7

Language：English Publishing type：Research paper (scientific journal) Publisher：ELSEVIER IRELAND LTD

Background: In intensive care observational studies, hypercapnia after cardiac arrest (CA) is independently associated with improved neurological outcome. However, the safety and feasibility of delivering targeted therapeutic mild hypercapnia (TTMH) for such patients is untested.
Methods: In a phase II safety and feasibility multi-centre, randomised controlled trial, we allocated ICU patients after CA to 24 h of targeted normocapnia (TN) (PaCO2 35-45 mmHg) or TTMH (PaCO2 50-55 mmHg). The primary outcome was serum neuron specific enolase (NSE) and S100b protein concentrations over the first 72 h assessed in the first 50 patients surviving to day three. Secondary end-points included global measure of function assessment at six months and mortality for all patients.
Results: We enrolled 86 patients. Their median age was 61 years (58, 64 years) and 66 (79%) were male. Of these, 50 patients (58%) survived to day three for full biomarker assessment. NSE concentrations increased in the TTMH group (p = 0.02) and TN group (p = 0.005) over time, with the increase being significantly more pronounced in the TN group (p(interaction)=0.04). S100b concentrations decreased over time in the TTMH group (p < 0.001) but not in the TN group (p = 0.68). However, the S100b change over time did not differ between the groups (p(interaction)=0.23). At six months, 23 (59%) TTMH patients had good functional recovery compared with 18 (46%) TN patients. Hospital mortality occurred in 11 (26%) TTMH patients and 15 (37%) TN patients (p = 0.31).
Conclusions: In CA patients admitted to the ICU, TTMH was feasible, appeared safe and attenuated the release of NSE compared with TN. These findings justify further investigation of this novel treatment. (C) 2016 Published by Elsevier Ireland Ltd.

DOI： 10.1016/j.resuscitation.2016.03.023

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

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-tp.jamas.or.jp/index.php?module=Default&action=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

Conservative oxygen therapy in mechanically ventilated patients following cardiac arrest: A retrospective nested cohort study Reviewed International journal

Glenn M. Eastwood, Aiko Tanaka, Emilo Daniel Valenzuela Espinoza, Leah Peck, Helen Young, Johan Martensson, Ling Zhang, Neil J. Glassford, Yu-Feng Frank Hsiao, Satoshi Suzuki, Rinaldo Bellomo

RESUSCITATION 101 108 - 114 2016.4

Language：English Publishing type：Research paper (scientific journal) Publisher：ELSEVIER IRELAND LTD

Background: In mechanically ventilated (MV) cardiac arrest (CA) survivors admitted to the intensive care unit (ICU) avoidance of hypoxia is considered crucial. However, avoidance of hyperoxia may also be important. A conservative approach to oxygen therapy may reduce exposure to both.
Methods: We evaluated the introduction of conservative oxygen therapy (target SpO(2) 88-92% using the lowest FiO(2)) during MV for resuscitated CA patients admitted to the ICU.
Results: We studied 912 arterial blood gas (ABG) datasets: 448 ABGs from 50 'conventional' and 464 ABGs from 50 'conservative' oxygen therapy patients. Compared to the conventional group, conservative group patients had significantly lower PaO2 values and FiO(2) exposure (p < 0.001, respectively); more received MV in a spontaneous ventilation mode (18% vs 2%; p = 0.001) and more were exposed to a FiO(2) of 0.21 (19 vs 0 patients, p = 0.001). Additionally, according to mean PaO2, more conservative group patients were classified as normoxaemic (36 vs 16 patients, p < 0.01) and fewer as hyperoxaemic (14 vs 33 patients, p < 0.01). Finally, ICU length of stay was significantly shorter for conservative group patients (p = 0.04). There was no difference in the proportion of survivors discharged from hospital with good neurological outcome (14/23 vs 12/22 patients, p = 0.67).
Conclusions: Our findings provide preliminary support for the feasibility and physiological safety of conservative oxygen therapy in patients admitted to ICU for MV support after cardiac arrest (Trial registration, NCT01684124). (C) 2015 Elsevier Ireland Ltd. All rights reserved.

DOI： 10.1016/j.resuscitation.2015.11.026

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