Faculty Profiles - SUZUKI Satoshi

Papers - SUZUKI Satoshi

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1576: INTRAOPERATIVE FLUID THERAPY IN VIDEO-ASSISTED THORACOSCOPIC ESOPHAGECTOMY: A RETROSPECTIVE STUDY

Yukiko Hikasa, Satoshi Suzuki, Tomoyuki Kanazawa, Masao Hayashi, Takashi Matsusaki, Kazuyoshi Shimizu, Hiroshi Morimatsu

Critical Care Medicine 44 ( 12 ) 469 - 469 2016

Urinary Neutrophil Gelatinase-Associated Lipocalin as Predictor of Short- or Long-Term Outcomes in Cardiac Surgery Patients Reviewed

Mercedes Garcia-Alvarez, Neil J. Glassford, Antoni J. Betbese, Jordi Ordonez, Victoria Banos, Marta Argilaga, Alfonso Martinez, Satoshi Suzuki, Antoine G. Schneider, Glenn M. Eastwood, M. Victoria Moral, Rinaldo Bellomo

JOURNAL OF CARDIOTHORACIC AND VASCULAR ANESTHESIA 29 ( 6 ) 1480 - 1488 2015.12

Language：English Publishing type：Research paper (scientific journal) Publisher：W B SAUNDERS CO-ELSEVIER INC

Objectives: To determine the ability of urinary neutrophil gelatinase-associated lipocalin (uNGAL) to predict cardiac surgery-associated acute kidney injury (CSA-AKI), continuous renal replacement therapy (CRRT), mortality, and a composite outcome of major adverse kidney events at 365 days (MAKE(365)), and to investigate the influence of cardiopulmonary bypass (CPB) on NGAL release.
Design: A prospective observational study.
Setting: A single-center university hospital.
Participants: A cohort of 288. adult cardiac surgery patients.
Interventions: uNGAL was measured at baseline, immediately after surgery, and on days 1 and 2 postoperatively. The authors used the recent Kidney Disease Improving Global Outcomes consensus criteria to define CSA-AKI.
Measurements and Main Results: CSA-AKI occurred in 36.1% of patients. uNGAL rapidly became significantly higher in patients who developed AKI, with peak value immediately after surgery (349.9 [76.6-1446.6] v 90.1 [20.8-328] ng/mg creatinine; p < 0.001). No measure of uNGAL (peak, postsurgery, day 1 or 2 postsurgery) accurately predicted CSA-AKI, CRRT, mortality, or MAKE365. However, immediately after surgery, CPB induced greater uNGAL release compared with off-pump surgery (265.5 mu mol/L [71-989.6] v 48.7 ng/mg creatinine [17-129.8]; p < 0.001). Moreover, such early uNGAL release correlated with CPB duration (r = 0.505; p < 0.001) but not with peak serum creatinine values on day 3 or 7 after surgery.
Conclusions: uNGAL had a limited predictive ability for CSA-AKI or other relevant clinical outcomes after cardiac surgery and appeared to be more closely related to the use and duration of CPB. Thus, its levels may represent the aggregate effect of an inflammatory response to CPB as well as a renal response to cardiac surgery and inflammation. (C) 2015 Elsevier Inc. All rights reserved.

DOI： 10.1053/j.jvca.2015.05.060

Atelectasis and mechanical ventilation mode during conservative oxygen therapy: A before-and-after study Reviewed International journal

Satoshi Suzuki, Glenn M. Eastwood, Mark D. Goodwin, Geertje D. Noe, Paul E. Smith, Neil Glassford, Antoine G. Schneider, Rinaldo Bellomo

JOURNAL OF CRITICAL CARE 30 ( 6 ) 1232 - 1237 2015.12

Language：English Publishing type：Research paper (scientific journal) Publisher：W B SAUNDERS CO-ELSEVIER INC

Purpose: The purpose of the study is to assess the effect of a conservative oxygen therapy (COT) (target SpO(2) of 90%-92%) on radiological atelectasis and mechanical ventilation modes.
Materials and methods: We conducted a secondary analysis of 105 intensive care unit patients from a pilot before-and-after study. The primary outcomes of this study were changes in atelectasis score (AS) of 555 chest radiographs assessed by radiologists blinded to treatment allocation and time to weaning from mandatory ventilation and first spontaneous ventilation trial (SVT).
Results: There was a significant difference in overall AS between groups, and COT was associated with lower time-weighted average AS. In addition, in COT patients, change from mandatory to spontaneous ventilation or time to first SVT was shortened. After adjustment for baseline characteristics and interactions between oxygen therapy, radiological atelectasis, and mechanical ventilation management, patients in the COT group had significantly lower "best" AS (adjusted odds ratio, 0.28 [95% confidence interval {CI}, 0.12-0.66]; P = .003) and greater improvement in AS in the first 7 days (adjusted odds ratio, 0.42 [95% CI, 0.17-0.99]; P = .049). Moreover, COT was associated with significantly earlier successful weaning from a mandatory ventilation mode (adjusted hazard ratio, 2.96 [95% CI, 1.73-5.04]; P < .001) and with shorter time to first SVT (adjusted hazard ratio, 1.77 [95% CI, 1.13-2.78]; P = .013).
Conclusions: In mechanically ventilated intensive care unit patients, COT might be associated with decreased radiological evidence of atelectasis, earlier weaning from mandatory ventilation modes, and earlier first trial of spontaneous ventilation. (C) 2015 Elsevier Inc. All rights reserved.

DOI： 10.1016/j.jcrc.2015.07.033

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/index.php?module=Default&action=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

Paracetamol therapy and outcome of critically ill patients: a multicenter retrospective observational study Reviewed International journal

Satoshi Suzuki, Glenn M. Eastwood, Michael Bailey, David Gattas, Peter Kruger, Manoj Saxena, John D. Santamaria, Rinaldo Bellomo

Critical Care 19 ( 1 ) 162 - 162 2015.4

Language：English Publishing type：Research paper (scientific journal) Publisher：BioMed Central Ltd.

Introduction: In this study, we aimed to examine the association between paracetamol administration in the intensive care unit (ICU) and mortality in critically ill patients. Methods: We conducted a multicenter retrospective observational study in four ICUs. We obtained information on paracetamol use, body temperature, demographic, clinical and outcome data from each hospital's clinical information system and admissions and discharges database. We performed statistical analysis to assess the association between paracetamol administration and hospital mortality. Results: We studied 15,818 patients with 691,348 temperature measurements at 4 ICUs. Of these patients, 10,046 (64%) received at least 1g of paracetamol. Patients who received paracetamol had lower in-hospital mortality (10% vs. 20%, P &lt
0.001), and survivors were more likely to have received paracetamol (66% vs. 46%
P &lt
0.001). However, patients treated with paracetamol were also more likely to be admitted to the ICU after surgery (70% vs. 51%
P &lt
0.001) and/or after elective surgery (55% vs. 37%
P &lt
0.001). In multivariate logistic regression analysis including a propensity score for paracetamol treatment, we found a significant and independent association between the use of paracetamol and reduced in-hospital mortality (adjusted odds ratio =0.60 (95% confidence interval (CI), 0.53 to 0.68), P &lt
0.001). Cox proportional hazards analysis showed that patients who received paracetamol also had a significantly longer time to death (adjusted hazard ratio =0.51 (95% CI, 0.46 to 0.56), P &lt
0.001). The association between paracetamol and decreased mortality and/or time to death was broadly consistent across surgical and medical patients. It remained present after adjusting for paracetamol administration as a time-dependent variable. However, when such time-dependent analysis was performed, the association of paracetamol with outcome lost statistical significance in the presence of fever and suspected infection and in patients in the lower tertiles of Acute Physiology and Chronic Health Evaluation II scores. Conclusions: Paracetamol administration is common in the ICU and appears to be independently associated with reduced in-hospital mortality and time to death after adjustment for multiple potential confounders and propensity score. This association, however, was modified by the presence of fever, suspected infection and lesser illness severity and may represent the effect of indication bias.

DOI： 10.1186/s13054-015-0865-1

A pilot feasibility, safety and biological efficacy multicentre trial of therapeutic hypercapnia after cardiac arrest: study protocol for a randomized controlled trial Reviewed

Glenn M. Eastwood, Antoine G. Schneider, Satoshi Suzuki, Michael Bailey, Rinaldo Bellomo

TRIALS 16 135 2015.4

Language：English Publishing type：Research paper (scientific journal) Publisher：BIOMED CENTRAL LTD

Background: Cardiac arrest causes ischaemic brain injury. Arterial carbon dioxide tension (PaCO2) is a major determinant of cerebral blood flow. Thus, mild hypercapnia in the 24 h following cardiac arrest may increase cerebral blood flow and attenuate such injury. We describe the Carbon Control and Cardiac Arrest (CCC) trial.
Methods/Design: The CCC trial is a pilot multicentre feasibility, safety and biological efficacy randomized controlled trial recruiting adult cardiac arrest patients admitted to the intensive care unit after return of spontaneous circulation. At admission, using concealed allocation, participants are randomized to 24 h of either normocapnia (PaCO2 35 to 45 mmHg) or mild hypercapnia (PaCO2 50 to 55 mmHg). Key feasibility outcomes are recruitment rate and protocol compliance rate. The primary biological efficacy and biological safety measures are the between-groups difference in serum neuron-specific enolase and S100b protein levels at 24 h, 48 h and 72 h. Secondary outcome measure include adverse events, in-hospital mortality, and neurological assessment at 6 months.
Discussion: The trial commenced in December 2012 and, when completed, will provide clinical evidence as to whether targeting mild hypercapnia for 24 h following intensive care unit admission for cardiac arrest patients is feasible and safe and whether it results in decreased concentrations of neurological injury biomarkers compared with normocapnia. Trial results will also be used to determine whether a phase IIb study powered for survival at 90 days is feasible and justified.

DOI： 10.1186/s13063-015-0676-3

A pilot assessment of alpha-stat vs pH-stat arterial blood gas analysis after cardiac arrest Reviewed

Glenn M. Eastwood, Satoshi Suzuki, Cristina Lluch, Antoine G. Schneider, Rinaldo Bellomo

JOURNAL OF CRITICAL CARE 30 ( 1 ) 138 - 144 2015.2

Language：English Publishing type：Research paper (scientific journal) Publisher：W B SAUNDERS CO-ELSEVIER INC

Purpose: Resuscitated cardiac arrest (CA) patients typically receive therapeutic hypothermia, but arterial blood gases (ABGs) are often assessed after adjustment to 37 degrees C (alpha-stat) instead of actual body temperature (pH-stat). We sought to compare alpha-stat and pH-stat assessment of Pao(2) and Paco(2) in such patients.
Materials and methods: Using ABG data obtained during the first 24 hours of intensive care unit admission, we determined the impact of measured alpha vs calculated pH-stat on Pao(2) and Paco(2) on patient classification and outcomes for CA patients.
Results: We assessed 1013 ABGs from 120 CA patients with a median age of patients 66 years (interquartile range, 50-76). Median alpha-stat Pao(2) changed from 122 (95-156) to 107 (82-143) mm Hg with pH-stat and median Paco(2) from 39 (34-46) to 35 (30-41) mm Hg (both P < .001). Using the categories of hyperoxemia, normoxemia, and hypoxemia, pH-stat estimation of Pao(2) reclassified approximately 20% of patients. Using the categories of hypercapnia, normocapnia, and hypocapnia, pH-stat estimation of Paco(2) reclassified approximately 40% of patients. The mortality of patients in different Pao(2) and Paco(2) categories was similar for pH-stat and alpha-stat.
Conclusions: Using the pH-stat method, fewer resuscitated CA patients admitted to intensive care unit were classified as hyperoxemic or hypercapnic compared with alpha-stat. These findings suggest an impact of ABG assessment methodology on Pao(2), Paco(2), and patient classification but not on associated outcomes. (C) 2014 Elsevier Inc. All rights reserved.

DOI： 10.1016/j.jcrc.2014.09.022

Pulse pressure variation-guided fluid therapy after cardiac surgery: A pilot before-and-after trial Reviewed

Satoshi Suzuki, Nicholas C. Z. Woinarski, Miklos Lipcsey, Cristina Lluch Candal, Antoine G. Schneider, Neil J. Glassford, Glenn M. Eastwood, Rinaldo Bellomo

JOURNAL OF CRITICAL CARE 29 ( 6 ) 992 - 996 2014.12

Language：English Publishing type：Research paper (scientific journal) Publisher：W B SAUNDERS CO-ELSEVIER INC

Purpose: The aim of this study is to study the feasibility, safety, and physiological effects of pulse pressure variation (PPV)-guided fluid therapy in patients after cardiac surgery.
Materials and methods: We conducted a pilot prospective before-and-after study during mandatory ventilation after cardiac surgery in a tertiary intensive care unit. We introduced a protocol to deliver a fluid bolus for a PPV >= 13% for at least >10 minutes during the intervention period.
Results: We studied 45 control patients and 53 intervention patients. During the intervention period, clinicians administered a fluid bolus on 79% of the defined PPV trigger episodes. Median total fluid intake was similar between 2 groups during mandatory ventilation (1297 mL[interquartile range 549-1968] vs 1481 mL [807-2563]; P =. 17) and the first 24 hours (3046 mL [interquartile range 2317-3982] vs 3017 mL [2192-4028]; P = .73). After adjusting for several baseline factors, PPV-guided fluid management significantly increased fluid intake during mandatory ventilation (P = .004) but not during the first 24 hours (P = .47). Pulse pressure variation-guided fluid therapy, however, did not significantly affect hemodynamic, renal, and metabolic variables. No serious adverse events were noted.
Conclusions: Pulse pressure variation-guided fluid management was feasible and safe during mandatory ventilation after cardiac surgery. However, its advantages may be clinically small. (C) 2014 Elsevier Inc. All rights reserved.

DOI： 10.1016/j.jcrc.2014.07.032

Intensive care clinicians' opinion of conservative oxygen therapy (SpO(2) 90-92%) for mechanically ventilated patients Reviewed

Glenn M. Eastwood, Leah Peck, Helen Young, Satoshi Suzuki, Mercedes Garcia, Rinaldo Bellomo

AUSTRALIAN CRITICAL CARE 27 ( 3 ) 120 - 125 2014.8

Language：English Publishing type：Research paper (scientific journal) Publisher：ELSEVIER SCIENCE INC

Background: In the ICU, SpO(2) >= 96% are regularly targeted implying that more oxygen may be given than desirable. To reduce exposure to hyperoxia a conservative oxygen therapy protocol (targeted SpO(2) 90-92% using lowest FiO(2)) for mechanically ventilated patients was introduced in a single tertiary ICU in September 2012.
Objectives: To describe intensive care clinicians' opinion of conservative oxygen therapy for mechanically ventilated adult patients.
Methods: A structured multi-choice questionnaire of intensive care clinicians was conducted between February and March 2013.
Results: Responses were received from 90 staff members: 81 intensive care nurses and 9 medical doctors. A majority of respondents (60.7%) considered oxygen related lung injury as 'a major concern'. Most respondents (81/89; 91.1%) felt conservative oxygen therapy was easy to perform and few respondents (6/88; 8%) considered performing conservative oxygen therapy to be stressful. Most respondents (58%) reported not performing more arterial blood gases to monitor PaO2 during conservative oxygen therapy and 90% (81/90) of respondents indicated a desire to continue conservative oxygen therapy. Free text comments indicated adoption of this protocol was a paradigm shift yet more education and research to elucidate the benefits/harm of lower oxygen saturation targeting is needed.
Conclusions: Intensive care clinicians readily accepted the introduction of a conservative oxygen therapy protocol into their practice. Most respondents found conservative oxygen therapy easy and not stressful to perform. Further evaluation the administration of oxygen therapy, its management by intensive care clinicians and possible impact on outcome for mechanically ventilated patients appears well accepted by clinical staff. (C) 2013 Published by Elsevier Australia (a division of Reed International Books Australia Pty Ltd) on behalf of Australian College of Critical Care Nurses Ltd.

DOI： 10.1016/j.aucc.2013.11.004

Conservative Oxygen Therapy in Mechanically Ventilated Patients: A Pilot Before-and-After Trial Reviewed

Satoshi Suzuki, Glenn M. Eastwood, Neil J. Glassford, Leah Peck, Helen Young, Mercedes Garcia-Alvarez, Antoine G. Schneider, Rinaldo Bellomo

CRITICAL CARE MEDICINE 42 ( 6 ) 1414 - 1422 2014.6

Language：English Publishing type：Research paper (scientific journal) Publisher：LIPPINCOTT WILLIAMS & WILKINS

Objectives: To assess the feasibility and safety of a conservative approach to oxygen therapy in mechanically ventilated ICU patients.
Design: Pilot prospective before-and-after study.
Setting: A 22-bed multidisciplinary ICU of a tertiary care hospital in Australia.
Patients: A total of 105 adult (18 years old or older) patients required mechanical ventilation for more than 48 hours: 51 patients during the conventional before period and 54 after a change to conservative oxygen therapy.
Interventions: Implementation of a conservative approach to oxygen therapy (target Spo(2) of 90-92%).
Measurements and Main Results: We collected 3,169 datasets on 799 mechanical ventilation days. During conservative oxygen therapy the median time-weighted average Spo(2) on mechanical ventilation was 95.5% (interquartile range, 94.0-97.3) versus 98.4% (97.3-99.1) (p < 0.001) during conventional therapy. The median Pao(2) was 83 torr (71-94) versus 107 torr (94-131) (p < 0.001) with a change to a median Fio(2) of 0.27 (0.24-0.30) versus 0.40 (0.35-0.44) (p < 0.001). Conservative oxygen therapy decreased the median total amount of oxygen delivered during mechanical ventilation by about two thirds (15,580 L [8,263-29,351 L] vs 5,122 L [1,837-10,499 L]; p < 0.001). The evolution of the Pao(2)/Fio(2) ratio was similar during the two periods, and there were no difference in any other biochemical or clinical outcomes.
Conclusions: Conservative oxygen therapy in mechanically ventilated ICU patients was feasible and free of adverse biochemical, physiological, or clinical outcomes while allowing a marked decrease in excess oxygen exposure. Our study supports the safety and feasibility of future pilot randomized controlled trials of conventional compared with conservative oxygen therapy.

DOI： 10.1097/CCM.0000000000000219

Mortality Related to Severe Sepsis and Septic Shock Among Critically III Patients in Australia and New Zealand, 2000-2012 Reviewed International journal

Kirsi-Maija Kaukonen, Michael Bailey, Satoshi Suzuki, David Pilcher, Rinaldo Bellomo

JAMA-JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION 311 ( 13 ) 1308 - 1316 2014.4

Language：English Publishing type：Research paper (scientific journal) Publisher：AMER MEDICAL ASSOC

IMPORTANCE Severe sepsis and septic shock are major causes of mortality in intensive care unit (ICU) patients. It is unknown whether progress has been made in decreasing their mortality rate.
OBJECTIVE To describe changes in mortality for severe sepsis with and without shock in ICU patients.
DESIGN, SETTING, AND PARTICIPANTS Retrospective, observational study from 2000 to 2012 including 101 064 patients with severe sepsis from 171 ICUs with various patient case mix in Australia and New Zealand.
MAIN OUTCOMES AND MEASURES Hospital outcome (mortality and discharge to home, to other hospital, or to rehabilitation).
RESULTS Absolute mortality in severe sepsis decreased from 35.0% (95% CI, 33.2%-36.8%; 949/2708) to 18.4% (95% CI, 17.8%-19.0%; 2300/12 512; P<.001), representing an overall decrease of 16.7% (95% CI, 14.8%-18.6%), an annual rate of absolute decrease of 1.3%, and a relative risk reduction of 47.5% (95% CI, 44.1%-50.8%). After adjusted analysis, mortality decreased throughout the study period with an odds ratio (OR) of 0.49 (95% CI, 0.46-0.52) in 2012, using the year 2000 as the reference (P<.001). The annual decline in mortality did not differ significantly between patients with severe sepsis and those with all other diagnoses (OR, 0.94 [95% CI, 0.94-0.95] vs 0.94 [95% CI, 0.94-0.94]; P = .37). The annual increase in rates of discharge to home was significantly greater in patients with severe sepsis compared with all other diagnoses (OR, 1.03 [95% CI, 1.02-1.03] vs 1.01 [95% CI, 1.01-1.01]; P<.001). Conversely, the annual increase in the rate of patients discharged to rehabilitation facilities was significantly less in severe sepsis compared with all other diagnoses (OR, 1.08 [95% CI, 1.07-1.09] vs 1.09 [95% CI, 1.09-1.10]; P<.001). In the absence of comorbidities and older age, mortality was less than 5%.
CONCLUSIONS AND RELEVANCE In critically ill patients in Australia and New Zealand with severe sepsis with and without shock, there was a decrease in mortality from 2000 to 2012. These findings were accompanied by changes in the patterns of discharge to home, rehabilitation, and other hospitals.

DOI： 10.1001/jama.2014.2637

Hyperoxemia in critically mechanical ventilation patients: A factor yet to be fit for intensivists-Authors' reply Reviewed International journal

Satoshi Suzuki, Glenn M. Eastwood, Rinaldo Bellomo

JOURNAL OF CRITICAL CARE 29 ( 1 ) 173 - 173 2014.2

Near-infrared spectroscopy of the thenar eminence to estimate forearm blood flow Reviewed International journal

Nicholas C. Z. Woinarski, Satoshi Suzuki, Miklos Lipcsey, Natalie Lumsden, Jaye Chin-Dusting, Antoine G. Schneider, Michael Bailey, Rinaldo Bellomo

CRITICAL CARE AND RESUSCITATION 15 ( 4 ) 323 - 326 2013.12

Language：English Publishing type：Research paper (scientific journal) Publisher：AUSTRALASIAN MED PUBL CO LTD

Background: Near-infrared spectroscopy of the thenar eminence (NIRSth) can be used at the bedside to assess tissue oxygenation (Sto(2)), the reperfusion response to ischaemia and the tissue haemoglobin index (THI). Its ability to estimate forearm blood flow (FBF) has not previously been assessed.
Objectives: We aimed to test whether short-lived venous occlusion-induced changes in NIRSth-derived THI (Delta THI/minute) correlate with strain gauge plethysmography (SGP) measurements.
Methods: We measured FBF in nine volunteers with SGP by venous occlusion, while estimating Delta THI. Measurements were obtained in two forearm positions (elevated and horizontal) at baseline and during induced hyperaemia.
Results: We performed 246 paired measurements at rest and after occlusion-induced hyperaemia. At rest, mean SGP-estimated FBF was 3.5-3.6 mL/dL/minute at baseline, compared with 12.9-13.6 mL/dL/minute during hyperaemia. At rest, Delta THI was 6.1-8.2/minute, compared with 29.7-32.5/minute during hyperaemia. Delta THI was a significant predictor of SGP FBF (P<0.01), with stronger correlation during hyperaemia (P<0.01). An equation was developed to convert Delta THI/minute into FBF at mL/dL/minute (FBF=0.362 x Delta THI/minute + 0.864).
Conclusions: NIRSth can be used to estimate FBF. Given its portability and its ability to also measure Sto(2) and vascular reactivity, NIRSth can assist in providing a comprehensive bedside assessment of the forearm circulation in critically ill patients.

Current oxygen management in mechanically ventilated patients: A prospective observational cohort study Reviewed International journal

Satoshi Suzuki, Glenn M. Eastwood, Leah Peck, Neil J. Glassford, Rinaldo Bellomo

JOURNAL OF CRITICAL CARE 28 ( 5 ) 647 - 654 2013.10

Language：English Publishing type：Research paper (scientific journal) Publisher：W B SAUNDERS CO-ELSEVIER INC

Purpose: Oxygen (O-2) is the most common therapy in mechanically ventilated patients, but targets and dose are poorly understood. We aimed to describe current O-2 administration and titration in such patients in an academic intensive care unit.
Materials and Methods: In consecutive ventilated (> 48 hours) patients we prospectively obtained fraction of inspired O-2 (FIO2), pulse oximetry O-2 saturation (SpO(2)) and arterial O-2 tension (PaO2) every 6 hours. We calculated the amount of excess O-2 delivery and the intensivists' response to hyperoxemia (SpO(2) > 98%).
Results: During 358 mechanical ventilation days in 51 critically ill patients, median calculated excess O-2 delivery was 3472 L per patient. Patients spent most of their time with their SpO(2) > 98% (59% [29-83]) and PaO2 between 80 and 120 mm Hg (59% [38-72]). In addition, 50% of all observations showed hyperoxemia and 4% severe hyperoxemia (PaO2 > 202.5 mm Hg). Moreover, 71% of the calculated total excess 263,841 L of O-2 was delivered when the FIO2 was 0.3 to 0.5. When hyperoxemia occurred with an FIO2 between 0.3 and 0.4, for 88% of episodes, no FIO2 adjustments were made.
Conclusions: Excess O-2 delivery and liberal O-2 therapy were common in mechanically ventilated patients. Current O-2 therapy practice may be suboptimal and further investigations are warranted. (C) 2013 Elsevier Inc. All rights reserved.

DOI： 10.1016/j.jcrc.2013.03.010

Hypophosphatemia in critically ill patients Reviewed International journal

Satoshi Suzuki, Moritoki Egi, Antoine G. Schneider, Rinaldo Bellomo, Graeme K. Hart, Colin Hegarty

Journal of Critical Care 28 ( 4 ) 536 - e19 2013.8

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

Purpose: The aim of this study was to assess the association of phosphate concentration with key clinical outcomes in a heterogeneous cohort of critically ill patients. Materials and Methods: This was a retrospective observational study at a general intensive care unit (ICU) of an Australian university teaching hospital enrolling 2730 adult critically ill patients. Results: We studied 10 504 phosphate measurements with a mean value of 1.17 mmol/L (measurements every 28.8 hours on average). Hyperphosphatemia (inorganic phosphate [iP] concentration &gt
1.4 mmol/L) occurred in 45% and hypophosphatemia (iP ≤ 0.6 mmol/L) in 20%. Among patients without any episodes of hyperphosphatemia, patients with at least 1 episode of hypophosphatemia had a higher ICU mortality than those without hypophosphatemia (P = .004). In addition, ICU nonsurvivors had lower minimum phosphate concentrations than did survivors (P = .009). Similar results were seen for hospital mortality. However, on multivariable logistic regression analysis, hypophosphatemia was not independently associated with ICU mortality (adjusted odds ratio, 0.86 [95% confidence interval, 0.66-1.10]
P = .24) and hospital mortality (odds ratio, 0.89 [0.73-1.07]
P = .21). Even when different cutoff points were used for hypophosphatemia (iP ≤ 0.5, 0.4, 0.3, or 0.2 mmol/L), hypophosphatemia was not an independent risk factor for ICU and hospital morality. In addition, timing of onset and duration of hypophosphatemia were not independent risk factor for ICU and hospital mortality. Conclusions: Hypophosphatemia behaves like a general marker of illness severity and not as an independent predictor of ICU or in-hospital mortality in critically ill patients. © 2013 Elsevier Inc.

DOI： 10.1016/j.jcrc.2012.10.011

Normothermic extracorporeal human liver perfusion following donation after cardiac death Reviewed

Rinaldo Bellomo, Bruno Marino, Graham Starkey, Bhao Zhong Wang, Michael A. Fink, Nan Zhu, Satoshi Suzuki, Shane Houston, Glenn Eastwood, Paolo Calzavacca, Neil Glassford, Brenton Chambers, Alison Skene, Antoine G. Schneider, Daryl Jones, Andrew Hilton, Helen Opdam, Stephen Warrillow, Nicole Gauthier, Lynne Johnson, Robert Jones

CRITICAL CARE AND RESUSCITATION 15 ( 2 ) 78 - 82 2013.6

Language：English Publishing type：Research paper (scientific journal) Publisher：AUSTRALASIAN MED PUBL CO LTD

Liver transplantation is a major life-saving procedure and donation after cardiac death (DCD) has increased the pool of potential liver donors.
However, livers procured after DCD are at increased risk of primary graft dysfunction and biliary tract ischaemia. Normothermic extracorporeal liver perfusion (NELP) may increase the ability to protect, evaluate and, in future, transplant DCD livers.
We conducted a proof-of-concept experiment using a human liver procured by DCD (deemed not suitable for liver donation) to assess the short-term (3 hours) feasibility,, histological effects and functional efficacy of NELP.
We used an extracorporeal membrane oxygenation circuit with separate hepatic artery and portal vein perfusion to achieve physiological perfusion pressures, and coupled this with parenteral nutrition and an insulin infusion. We achieved NELP with evidence of liver function (bile production, paracetamol removal and control of ammonia, bilirubin and lactate levels) for 3 hours. There was essentially normal liver and biliary tract histology after 8 hours of perfusion.
Our experiment justifies further investigation of the feasibility and efficacy of human DCD liver preservation by NELP.

Normothermic extracorporeal perfusion of isolated porcine liver after warm ischaemia: a preliminary report Reviewed

Rinaldo Bellomo, Satoshi Suzuki, Bruno Marino, Graeme K. Starkey, Brenton Chambers, Michael A. Fink, Bao Zhong Wang, Shane Houston, Glenn Eastwood, Paolo Calzavacca, Neil Glassford, Alison Skene, Daryl A. Jones, Robert Jones

CRITICAL CARE AND RESUSCITATION 14 ( 3 ) 173 - 176 2012.9

Language：English Publishing type：Research paper (scientific journal) Publisher：AUSTRALASIAN MED PUBL CO LTD

Liver transplantation is a major life-saving procedure, and donation after cardiac death (DCD) has increased the pool of potential liver donors.
However, DCD livers are at increased risk of primary graft dysfunction and biliary tract ischaemia. Normothermic extracorporeal liver perfusion (NELP) may increase the ability to protect, evaluate and, in future, transplant DCD livers.
We conducted proof-of-concept experiments using a DCD model in the pig to assess the short-term (4 hours) feasibility and functional efficacy of NELP. Using extracorporeal membrane oxygenation, parenteral nutrition, separate hepatic artery and portal vein perfusion, and physiological perfusion pressures, we achieved NELP and evidence of function (bile production, paracetamol removal, maintenance of normal ammonia and lactate levels) for 4 hours in pig livers subjected to 15 and 30 minutes of cardiac arrest before explantation.
Our experiments justify further investigations of the feasibility and efficacy of human DCD liver preservation by ex-vivo perfusion.

血漿交換が奏功した重症毛細血管漏出症候群(SCLS)の一症例

日笠友起子, 林真雄, 鈴木聡, 江木盛時, 小幡典彦, 森松博史, 森田潔

日本集中治療医学会雑誌 19 ( Suppl. ) 245 - 245 2012.1

Effect of tranexamic acid on blood loss in pediatric cardiac surgery: a randomized trial Reviewed

Kazuyoshi Shimizu, Yuichiro Toda, Tatsuo Iwasaki, Mamoru Takeuchi, Hiroshi Morimatsu, Moritoki Egi, Tomohiko Suemori, Satoshi Suzuki, Kiyoshi Morita, Shunji Sano

JOURNAL OF ANESTHESIA 25 ( 6 ) 823 - 830 2011.12

Language：English Publishing type：Research paper (scientific journal) Publisher：SPRINGER TOKYO

Purpose The benefit of tranexamic acid (TXA) in pediatric cardiac surgery on postoperative bleeding has varied among studies. It is also unclear whether the effects of TXA differ between cyanotic patients and acyanotic patients. The aim of this study was to test the benefit of TXA in pediatric cardiac surgery in a well-balanced study population of cyanotic and acyanotic patients.
Methods A total of 160 pediatric patients undergoing cardiac surgery with cardiopulmonary bypass (81 cyanotic, 79 acyanotic) were included in this single-blinded, randomized trial at a tertiary care university-affiliated teaching hospital. Eighty-one children (41 cyanotic, 40 acyanotic) were randomly assigned to a TXA group, in which they received 50 mg/kg of TXA as a bolus followed by 15 mg/kg/h infusion and another 50 mg/kg into the bypass circuit. The other 79 patients were randomly assigned to a placebo group. The primary end point was the amount of 24-h blood loss.
Results The amount of 24-h blood loss was significantly less in the TXA group than in the placebo group [mean (95% confidence interval): 18.6 (15.8-21.4) vs. 23.5 (19.4-27.5) ml/kg, respectively; mean difference -4.9 (-9.7 to -0.01) ml/kg; p = 0.049]. This effect of TXA was already significant at 6 h [9.5 (7.5-11.5) vs. 13.2 (10.6-15.9) ml/kg, respectively; mean difference -3.47 (-7.0 to -0.4) ml/kg; p = 0.027]. However, there was no significant difference in the amount of blood transfusion between the groups. There was also no statistical difference in the effect of TXA in each cyanotic and acyanotic subgroup.
Conclusion TXA can reduce blood loss in pediatric cardiac surgery but not the transfusion requirement (http://ClinicalTrials.gov number NCT00994994).

DOI： 10.1007/s00540-011-1235-z

食道癌術後の難治性発作性心房細動に対して塩酸ランジオロールを使用した7例の検討.

鈴木聡, 森松博史, 江木盛時, 清水一好, 松崎孝, 佐藤哲文, 片山浩, 森田潔

日本集中治療医学会雑誌 18 ( 2 ) 215 - 220 2011

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

術後の発作性心房細動の発生は、ICUや病院滞在日数、医療費の増加につながることが報告されており、その管理は重要である。我々は、食道癌術後に難治性の発作性心房細動を合併し、短時間作用型β1選択的遮断薬である塩酸ランジオロールを使用した7例を経験した。症例は51〜87歳で、いずれも男性であった。複数の抗不整脈薬が無効であり、塩酸ランジオロール投与を開始した。初期の急速投与は行わず、4.3〜33.5μg/kg/minと低用量の範囲で開始し、投与前と投与1時間後の心拍数は平均153[140、167][95%信頼区間]/minから101[88、116]/min(P<0.0001)と有意な低下を認めた。平均血圧は88[78、94]mmHgから82[74、89]mmHg(P=0.37)と有意な変化を認めず、重症な低血圧に陥る症例もなかった。6例では投与開始24時間以内に洞調律に回復した。複数の抗不整脈薬に抵抗性の食道癌術後発作性心房細動に対する低用量の塩酸ランジオロール投与は、大きな血圧の低下なく心拍数の安定をもたらした。(著者抄録)

DOI： 10.3918/jsicm.18.215

Other Link： https://search.jamas.or.jp/index.php?module=Default&action=Link&pub_year=2011&ichushi_jid=J02874&link_issn=&doc_id=20110422460012&doc_link_id=20110422460001%2C20111017450026&url=http%3A%2F%2Fsearch.jamas.or.jp%2Flink%2Fbc%2F20110422460001%2C20111017450026&type=jamaslink&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F99999_1.gif

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