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  2. 西田 修

西田 修

ニシダ オサム  (nishida osamu)

基本情報

所属
藤田医科大学 医学部 医学科 麻酔・侵襲制御医学 教授
学位
博士(医学）
J-GLOBAL ID
201501003665452510
researchmap会員ID
7000013286

研究キーワード

 1

研究分野

 1

論文

 249
  • Tomoyuki Nakamura, Naohide Kuriyama, Yoshitaka Hara, Tomoaki Yamashiro, Satoshi Komatsu, Takahiro Kawaji, Seiko Hayakawa, Hidefumi Komura, Chizuru Yamashita, Osamu Nishida
    Journal of artificial organs : the official journal of the Japanese Society for Artificial Organs 27(3) 306-310 2024年9月  
    We report a case in which excessive negative pressure may have been applied to the proximal side hole of a drainage cannula during venovenous extracorporeal membrane oxygenation (V-V ECMO), resulting in abnormal stenosis of the drainage cannula. V-V ECMO was introduced in a 71-year-old male patient who was transferred from another hospital for severe respiratory failure associated with varicella pneumonia and acute respiratory distress syndrome. Drainage was performed using a PCKC-V™ 24Fr (MERA, Japan) cannula via the right femoral vein with the tip of the cannula near the level of the diaphragm under fluoroscopy. Reinfusion was performed via the right internal jugular vein. Due to poor systemic oxygenation, the drainage cannula was withdrawn caudally and refixed to reduce the effect of recirculation. Two days later, drainage pressure dropped rapidly, and frequent ECMO flow interruption occurred due to poor drainage. An abdominal X-ray revealed abnormal stenosis of the proximal side hole site of the drainage cannula. We diagnosed that the drainage cannula was damaged, and it was replaced with another, namely a Medtronic Bio-Medicus™ 25 Fr (GETINGE, Sweden) cannula. However, the removed drainage cannula was not damaged, suggesting that the cannula was temporarily stenosed by momentary excessive negative pressure. In a multi-stage drainage cannula, the main drainage site is the proximal side hole, with little negative pressure applied at the apical foramen in a mock experimental ex vivo drainage test in a water tank. Hence, improvement of a multi-stage drainage cannula is recommended, such as adequate reinforcement of the side hole site with a wire.
  • Shigeaki Inoue, Nobuto Nakanishi, Fumimasa Amaya, Yoshihisa Fujinami, Junji Hatakeyama, Toru Hifumi, Yuki Iida, Daisuke Kawakami, Yusuke Kawai, Yutaka Kondo, Keibun Liu, Kensuke Nakamura, Takeshi Nishida, Hidenori Sumita, Shunsuke Taito, Shunsuke Takaki, Norihiko Tsuboi, Takeshi Unoki, Yasuyo Yoshino, Osamu Nishida
    Acute medicine & surgery 11(1) e929 2024年  
    Post-intensive care syndrome comprises physical, cognitive, and mental impairments in patients treated in an intensive care unit (ICU). It occurs either during the ICU stay or following ICU discharge and is related to the patients' long-term prognosis. The same concept also applies to pediatric patients, and it can greatly affect the mental status of family members. In the 10 years since post-intensive care syndrome was first proposed, research has greatly expanded. Here, we summarize the recent evidence on post-intensive care syndrome regarding its pathophysiology, epidemiology, assessment, risk factors, prevention, and treatments. We highlight new topics, future directions, and strategies to overcome post-intensive care syndrome among people treated in an ICU. Clinical and basic research are still needed to elucidate the mechanistic insights and to discover therapeutic targets and new interventions for post-intensive care syndrome.
  • Kensuke Nakamura, Junji Hatakeyama, Keibun Liu, Kazuma Yamakawa, Takeshi Nishida, Shinichiro Ohshimo, Shigeaki Inoue, Satoru Hashimoto, Shuhei Maruyama, Daisuke Kawakami, Yoshitaka Ogata, Katsura Hayakawa, Hiroaki Shimizu, Taku Oshima, Tatsuya Fuchigami, Osamu Nishida
    Journal of clinical biochemistry and nutrition 74(1) 74-81 2024年1月  
    The impact of nutrition therapy in the acute phase on post-intensive care syndrome (PICS) remains unclear. We conducted a multicenter prospective study on adult patients with COVID-19 who required mechanical ventilation for more than three days. The questionnaire was mailed after discharge. Physical PICS, defined as less than 90 points on the Barthel index (BI), was assigned as the primary outcome. We examined the types of nutrition therapy in the first week that affected PICS components. 269 eligible patients were evaluated 10 months after discharge. Supplemental parenteral nutrition (SPN) >400 kcal/day correlated with a lower occurrence of physical PICS (10% vs 21.92%, p = 0.042), whereas the amounts of energy and protein provided, early enteral nutrition, and a gradual increase in nutrition delivery did not, and none correlated with cognitive or mental PICS. A multivariable regression analysis revealed that SPN had an independent impact on physical PICS (odds ratio 0.33, 95% CI 0.12-0.92, p = 0.034), even after adjustments for age, sex, body mass index and severity. Protein provision ≥1.2 g/kg/day was associated with a lower occurrence of physical PICS (odds ratio 0.42, 95% CI 0.16-1.08, p = 0.071). In conclusion, SPN in the acute phase had a positive impact on physical PICS for ventilated patients with COVID-19.
  • Takeshi Unoki, Kei Hayashida, Yusuke Kawai, Shunsuke Taito, Morihide Ando, Yuki Iida, Fumihito Kasai, Tatsuya Kawasaki, Ryo Kozu, Yutaka Kondo, Masakazu Saitoh, Hideaki Sakuramoto, Nobuyuki Sasaki, Ryuichi Saura, Kensuke Nakamura, Akira Ouchi, Saiko Okamoto, Masatsugu Okamura, Tomoki Kuribara, Akira Kuriyama, Yujiro Matsuishi, Norimasa Yamamoto, Shodai Yoshihiro, Taisuke Yasaka, Ryo Abe, Takahito Iitsuka, Hiroyasu Inoue, Yuki Uchiyama, Satoshi Endo, Kazuki Okura, Kohei Ota, Takahisa Otsuka, Daisuke Okada, Kengo Obata, Yukiko Katayama, Naoki Kaneda, Mio Kitayama, Shunsuke Kina, Ryuichi Kusaba, Masanari Kuwabara, Naoki Sasanuma, Masahiro Takahashi, Chihiro Takayama, Naonori Tashiro, Junko Tatsuno, Takahiko Tamura, Mitsuhiro Tamoto, Asuka Tsuchiya, Yusuke Tsutsumi, Tadashi Nagato, Chihiro Narita, Tomohiro Nawa, Tadayoshi Nonoyama, Masatoshi Hanada, Kotaro Hirakawa, Akiko Makino, Hirotaka Masaki, Ryosuke Matsuki, Shinya Matsushima, Wataru Matsuda, Saori Miyagishima, Masaru Moromizato, Naoya Yanagi, Kota Yamauchi, Yuhei Yamashita, Natsuhiro Yamamoto, Keibun Liu, Yuki Wakabayashi, Shinichi Watanabe, Hiroshi Yonekura, Nobuto Nakanishi, Tetsuya Takahashi, Osamu Nishida
    Journal of intensive care 11(1) 47-47 2023年11月7日  
    Providing standardized, high-quality rehabilitation for critically ill patients is a crucial issue. In 2017, the Japanese Society of Intensive Care Medicine (JSICM) promulgated the "Evidence-Based Expert Consensus for Early Rehabilitation in the Intensive Care Unit" to advocate for the early initiation of rehabilitations in Japanese intensive care settings. Building upon this seminal work, JSICM has recently conducted a rigorous systematic review utilizing the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) methodology. This endeavor resulted in the formulation of Clinical Practice Guidelines (CPGs), designed to elucidate best practices in early ICU rehabilitation. The primary objective of this guideline is to augment clinical understanding and thereby facilitate evidence-based decision-making, ultimately contributing to the enhancement of patient outcomes in critical care settings. No previous CPGs in the world has focused specifically on rehabilitation of critically ill patients, using the GRADE approach. Multidisciplinary collaboration is extremely important in rehabilitation. Thus, the CPGs were developed by 73 members of a Guideline Development Group consisting of a working group, a systematic review group, and an academic guideline promotion group, with the Committee for the Clinical Practice Guidelines of Early Mobilization and Rehabilitation in Intensive Care of the JSICM at its core. Many members contributed to the development of the guideline, including physicians and healthcare professionals with multiple and diverse specialties, as well as a person who had been patients in ICU. Based on discussions among the group members, eight important clinical areas of focus for this CPG were identified. Fourteen important clinical questions (CQs) were then developed for each area. The public was invited to comment twice, and the answers to the CQs were presented in the form of 10 GRADE recommendations and commentary on the four background questions. In addition, information for each CQ has been created as a visual clinical flow to ensure that the positioning of each CQ can be easily understood. We hope that the CPGs will be a useful tool in the rehabilitation of critically ill patients for multiple professions.
  • Ken Sawada, Yasuyo Shimomura, Daisuke Hasegawa, Tatsuhiko Harada, Tomoyuki Nakamura, Naohide Kuriyama, Yoshitaka Hara, Hidefumi Komura, Osamu Nishida
    Fujita medical journal 9(2) 95-100 2023年5月  
    OBJECTIVES: Damage associated molecular patterns (DAMPs) levels are associated with sepsis severity and prognosis. Histone and high mobility group box 1 (HMGB1) levels are also potential indicators of prognosis. We investigated the relationship between serum histone H3 and HMGB1 levels and the illness severity score and prognosis in postoperative patients. METHODS: Postoperative serum histone H3 and HMGB1 levels in 39 intensive care unit (ICU) patients treated at our institution were measured. The correlation between peak histone H3 and HMGB1 levels in each patient and clinical data (age, sex, surgical time, length of ICU stay, and survival after ICU discharge), which also included the patients' illness severity score, was examined. RESULTS: Histone H3 but not HMGB1 levels were positively correlated with surgical time, the Sequential Organ Failure Assessment score, the Japanese Association for Acute Medicine acute phase disseminated intravascular coagulation diagnosis score, and the length of ICU stay. Both histone H3 and HMGB1 levels were negatively correlated with age. However, survival post-ICU discharge was not correlated with histone H3 or HMGB1 levels. CONCLUSIONS: Histone H3 levels are correlated with severity scores and the length of ICU stay. Serum histone H3 and HMGB1 levels are elevated postoperatively. These DAMPs, however, are not prognostic indicators in postoperative ICU patients.
  • 青木 善孝, 矢田部 智昭, 大下 慎一郎, 近藤 豊, 對東 俊介, 一二三 亨, 山川 一馬, 江木 盛時, 小倉 裕司, 久志本 成樹, 西田 修, 日本版敗血症診療ガイドライン2020特別委員会アンケート調査班
    日本救急医学会雑誌 33(11) 970-980 2022年11月  
    日本版敗血症診療ガイドライン(The Japanese Clinical Practice Guidelines for Management of Sepsis and Septic Shock: J-SSCG)2020特別委員会は,J-SSCG2020の使用状況と認知度,および,今後の改善点を検討するために,オンラインアンケートを実施した。J-SSCG2020を合同作成した日本集中治療医学会と日本救急医学会の2学会の会員には使用状況を調査するために最大22項目,J-SSCG2020を後援いただいた16学会の会員には認知度を調査するために最大10項目の質問を実施した。2学会会員を対象としたアンケートは450名より回答を得た。敗血症診療にJ-SSCG2020を参考にするとの回答は88%であった。敗血症患者の何%くらいでJ-SSCG2020に準じた診療が行われているかという質問には,75%程度であるとの回答が最多(54%)であった。J-SSCG2020で取り上げた22項目のうち特に遵守している項目に対する回答者数の割合は,3～62%と項目ごとに大きなばらつきがみられた。また,日本の敗血症診療におけるJ-SSCG2020の役割について,診療の標準化(87%),教育の向上(64%)の点で特に評価されていた。J-SSCG2016アンケート結果との比較では,J-SSCG2020の方がより広く敗血症診療に利用されていた。16学会会員対象のアンケートは764名より回答を得た。J-SSCG2020の認知度は72%であった。認知している回答者のうち81%が敗血症診療に利用し,うち95%は役に立つとの回答であった。一方,J-SSCG2020の問題点としては,内容が多すぎるという意見が最多であった。日本医療機能評価機構EBM普及推進事業(Minds)によるThe Appraisal of Guidelines for Research and Evaluation(AGREE II)を用いた評価では,J-SSCG2020の全体評価は88%であった。以上から,集中治療医や救急医のみならず,一般臨床家を対象として幅広く敗血症診療を支援するというJ-SSCG2020の主要な目的はある程度達成されていることが示唆された。一方,領域や臨床疑問(clinical question:CQ)数の見直しなど今後の改訂に向けた課題も明らかになった。(著者抄録)
  • 青木 善孝, 矢田部 智昭, 大下 慎一郎, 近藤 豊, 對東 俊介, 一二三 亨, 山川 一馬, 江木 盛時, 小倉 裕司, 久志本 成樹, 西田 修, 日本版敗血症診療ガイドライン2020特別委員会アンケート調査班
    日本集中治療医学会雑誌 29(6) 609-619 2022年11月  
    日本版敗血症診療ガイドライン(The Japanese Clinical Practice Guidelines for Management of Sepsis and Septic Shock,J-SSCG)2020特別委員会は,J-SSCG2020の使用状況と認知度,および,今後の改善点を検討するために,オンラインアンケートを実施した。J-SSCG2020を合同作成した日本集中治療医学会と日本救急医学会の2学会の会員には使用状況を調査するために最大22項目,J-SSCG2020を後援いただいた16学会の会員には認知度を調査するために最大10項目の質問を実施した。2学会会員を対象としたアンケートは450名より回答を得た。敗血症診療にJ-SSCG2020を参考にするとの回答は88%であった。敗血症患者の何%くらいでJ-SSCG2020に準じた診療が行われているかという質問には,75%程度であるとの回答が最多(54%)であった。J-SSCG2020で取り上げた22項目のうち特に遵守している項目に対する回答者数の割合は,3～62%と項目ごとに大きなばらつきがみられた。また,日本の敗血症診療におけるJ-SSCG2020の役割については,診療の標準化(87%),教育の向上(64%)の点で特に評価されていた。J-SSCG2016アンケート結果との比較では,J-SSCG2020の方がより広く敗血症診療に利用されていた。16学会会員対象のアンケートは764名より回答を得た。J-SSCG2020の認知度は72%であった。認知している回答者のうち81%が敗血症診療に利用し,うち95%は役に立つとの回答であった。一方,J-SSCG2020の問題点としては,内容が多すぎるという意見が最多であった。日本医療機能評価機構EBM普及推進事業(Minds)によるThe Appraisal of Guidelines for Research and Evaluation(AGREE II)を用いた評価では,J-SSCG2020の全体評価は88%であった。以上から,集中治療医や救急医のみならず,一般臨床家を対象として幅広く敗血症診療を支援するというJ-SSCG2020の主要な目的はある程度達成されていることが示唆された。一方,領域や臨床疑問(clinical question,CQ)数の見直しなど今後の改訂に向けた課題も明らかになった。(著者抄録)
  • 青木 善孝, 矢田部 智昭, 大下 慎一郎, 近藤 豊, 對東 俊介, 一二三 亨, 山川 一馬, 江木 盛時, 小倉 裕司, 久志本 成樹, 西田 修, 日本版敗血症診療ガイドライン2020特別委員会アンケート調査班
    日本救急医学会雑誌 33(11) 970-980 2022年11月  
    日本版敗血症診療ガイドライン(The Japanese Clinical Practice Guidelines for Management of Sepsis and Septic Shock: J-SSCG)2020特別委員会は,J-SSCG2020の使用状況と認知度,および,今後の改善点を検討するために,オンラインアンケートを実施した。J-SSCG2020を合同作成した日本集中治療医学会と日本救急医学会の2学会の会員には使用状況を調査するために最大22項目,J-SSCG2020を後援いただいた16学会の会員には認知度を調査するために最大10項目の質問を実施した。2学会会員を対象としたアンケートは450名より回答を得た。敗血症診療にJ-SSCG2020を参考にするとの回答は88%であった。敗血症患者の何%くらいでJ-SSCG2020に準じた診療が行われているかという質問には,75%程度であるとの回答が最多(54%)であった。J-SSCG2020で取り上げた22項目のうち特に遵守している項目に対する回答者数の割合は,3〜62%と項目ごとに大きなばらつきがみられた。また,日本の敗血症診療におけるJ-SSCG2020の役割について,診療の標準化(87%),教育の向上(64%)の点で特に評価されていた。J-SSCG2016アンケート結果との比較では,J-SSCG2020の方がより広く敗血症診療に利用されていた。16学会会員対象のアンケートは764名より回答を得た。J-SSCG2020の認知度は72%であった。認知している回答者のうち81%が敗血症診療に利用し,うち95%は役に立つとの回答であった。一方,J-SSCG2020の問題点としては,内容が多すぎるという意見が最多であった。日本医療機能評価機構EBM普及推進事業(Minds)によるThe Appraisal of Guidelines for Research and Evaluation(AGREE II)を用いた評価では,J-SSCG2020の全体評価は88%であった。以上から,集中治療医や救急医のみならず,一般臨床家を対象として幅広く敗血症診療を支援するというJ-SSCG2020の主要な目的はある程度達成されていることが示唆された。一方,領域や臨床疑問(clinical question:CQ)数の見直しなど今後の改訂に向けた課題も明らかになった。(著者抄録)
  • 青木 善孝, 矢田部 智昭, 大下 慎一郎, 近藤 豊, 對東 俊介, 一二三 亨, 山川 一馬, 江木 盛時, 小倉 裕司, 久志本 成樹, 西田 修, 日本版敗血症診療ガイドライン2020特別委員会アンケート調査班
    日本集中治療医学会雑誌 29(6) 609-619 2022年11月  
    日本版敗血症診療ガイドライン(The Japanese Clinical Practice Guidelines for Management of Sepsis and Septic Shock,J-SSCG)2020特別委員会は,J-SSCG2020の使用状況と認知度,および,今後の改善点を検討するために,オンラインアンケートを実施した。J-SSCG2020を合同作成した日本集中治療医学会と日本救急医学会の2学会の会員には使用状況を調査するために最大22項目,J-SSCG2020を後援いただいた16学会の会員には認知度を調査するために最大10項目の質問を実施した。2学会会員を対象としたアンケートは450名より回答を得た。敗血症診療にJ-SSCG2020を参考にするとの回答は88%であった。敗血症患者の何%くらいでJ-SSCG2020に準じた診療が行われているかという質問には,75%程度であるとの回答が最多(54%)であった。J-SSCG2020で取り上げた22項目のうち特に遵守している項目に対する回答者数の割合は,3〜62%と項目ごとに大きなばらつきがみられた。また,日本の敗血症診療におけるJ-SSCG2020の役割については,診療の標準化(87%),教育の向上(64%)の点で特に評価されていた。J-SSCG2016アンケート結果との比較では,J-SSCG2020の方がより広く敗血症診療に利用されていた。16学会会員対象のアンケートは764名より回答を得た。J-SSCG2020の認知度は72%であった。認知している回答者のうち81%が敗血症診療に利用し,うち95%は役に立つとの回答であった。一方,J-SSCG2020の問題点としては,内容が多すぎるという意見が最多であった。日本医療機能評価機構EBM普及推進事業(Minds)によるThe Appraisal of Guidelines for Research and Evaluation(AGREE II)を用いた評価では,J-SSCG2020の全体評価は88%であった。以上から,集中治療医や救急医のみならず,一般臨床家を対象として幅広く敗血症診療を支援するというJ-SSCG2020の主要な目的はある程度達成されていることが示唆された。一方,領域や臨床疑問(clinical question,CQ)数の見直しなど今後の改訂に向けた課題も明らかになった。(著者抄録)
  • 川治 崇泰, 森山 和広, 山下 千鶴, 西田 修
    Clinical Engineering 33(10) 964-969 2022年9月  
    ＜文献概要＞周術期に血液浄化法を施行する場合,周術期の急性腎障害(AKI)に対するものと維持透析患者に対するものがある.周術期の臓器障害のなかでAKIの頻度は高く,特に心臓血管外科手術後に発症することが多い.本稿ではおもに心臓血管外科周術期のAKIと,それに対する急性血液浄化法について論じる.
  • Tomoyuki Nakamura, Kazuhiro Moriyama, Naohide Kuriyama, Yoshitaka Hara, Satoshi Komatsu, Takahiro Kawaji, Yu Kato, Takuma Ishihara, Ayumi Shintani, Osamu Nishida
    Membranes 12(8) 2022年8月22日  
    Blood purification is performed to control cytokines in critically ill patients. The relationship between the clearance (CL) and the membrane area during adsorption is not clear. We hypothesized that the CL increases with the hydrophobic area when hydrophobic binding contributes to cytokine adsorption. We investigated the relationship between the hemofilter membrane area and the CL of the high mobility group box 1 protein (HMGB-1) and interleukin-6 (IL-6). We performed experimental hemofiltration in vitro using polymethyl methacrylate membranes CH-1.8W (1.8 m2) and CH-1.0N (1.0 m2), as well as polysulfone membrane NV-18X (1.8 m2). After adding 100 mg of HMGB1 or 10 μg of IL-6 into the test solution, experimental hemofiltration was conducted for 360 min in a closed-loop circulation system, and the same amount of HMGB1 and IL-6 was added after 180 min. With CH-1.8W and CH-1.0N, both HMGB-1 and IL-6 showed a rapid concentration decrease of more than 70% at 180 min and 360 min after the re-addition. At 15 min, the CL of HMGB-1 was CH-1.8W: 28.4 and CH-1.0N: 19.8, and that of IL-6 was CH-1.8W: 41.1 and CH-1.0N: 25.4. CH-1.8W and CH-1.0N removed HMGB1 and IL-6 by adsorption and CH-1.8W was superior in CL, which increased with a greater membrane area.
  • 山下 千鶴, 西田 修, 森山 和広
    月刊レジデント 15(1) 78-90 2022年8月  
    ＜Point(1)＞血液吸着の原理を説明できる。＜Point(2)＞血液吸着療法の種類と適用を説明できる。＜Point(3)＞敗血症の病態とエンドトキシンの関わりを説明できる。＜Point(4)＞PMX-DHPの目的を説明できる。＜Point(5)＞PMX-DHPの有効性を期待できる疾患を説明できる。(著者抄録)
  • Keibun Liu, Kensuke Nakamura, Sapna R. Kudchadkar, Hajime Katsukawa, Peter Nydahl, Eugene Wesley Ely, Kunihiko Takahashi, Shigeaki Inoue, Osamu Nishida
    Journal of Intensive Care Medicine 088506662210976-088506662210976 2022年4月27日  
    Background Mobilization and acute rehabilitation are essential in the intensive care unit (ICU), with substantial evidence supporting their benefits. This study aimed to characterize ICU mobilization practices during the COVID-19 pandemic for patients with and without COVID-19. Methods This was a secondary analysis of an international point prevalence study. All ICUs across the world were eligible to participate and were required to enroll all patients in each ICU on the survey date, 27 January 2021. The primary outcome was the achievement of mobilization at the level of sitting over the edge of the bed. Independent factors associated with mobilization, including COVID-19 infection, were analyzed by multivariable analysis. Results A total of 135 ICUs in 33 countries participated, for inclusion of 1229 patients. Among patients who were not receiving mechanical ventilation (MV), those with COVID-19 infection were mobilized more than those without COVID-19 (60% vs. 34%, p < 0.001). Among patients who were receiving MV, mobilization was low in both groups (7% vs. 9%, p = .56). These findings were consistent irrespective of ICU length of stay. Multivariable analysis showed that COVID-19 infection was associated with achievement of mobilization in patients without (adjusted odds ratio [aOR] = 4.48, 95% confidence interval [CI] = 2.71-7.42) and with MV (aOR = 2.13, 95% CI = 1.00-4.51). Factors that prevented mobilization were prone positioning in patients without MV and continuous use of neuromuscular blockade and sedation agents in patients with MV, whereas facilitating factors were the presence of targets/goals in both groups. Conclusion Mobilization rates for ICU patients across the globe are severely low, with the greatest immobility observed in mechanically ventilated patients. Although COVID-19 is not an independent barrier to the mobilization of patients with or without MV, this study has highlighted the current lack of mobility practice for all ICU patients during the COVID-19 pandemic. (299 words)
  • 河合 佑亮, 一二三 亨, 小幡 賢吾, 飯田 有輝, 畠山 淳司, 山川 一馬, 中村 謙介, 卯野木 健, 川上 大裕, 中西 信人, 劉 啓文, 新谷 歩, 井上 茂亮, 西田 修, 日本集中治療医学会PICS対策・生活の質改善検討委員会
    日本集中治療医学会雑誌 29(2) 165-176 2022年3月  
    【目的】Post-intensive care syndrome(PICS)対策としてのICU退室後のフォローアップに関する実態を明らかにする。【方法】2021年5月7～31日に日本集中治療医学会会員が勤務するICUを対象とし,インターネット上での調査を実施した。【結果】110ユニットのICUのうち,75.5%でPICSという用語や疾患概念が周知・使用され,89.1%で早期リハビリテーションが実施されていたが,55.5%でPICSに関する評価が実施されていなかった。ICU退室先の部署への訪問,PICS外来,退院後の医療機関などへの病院からのPICSに関する情報提供の実施率は,それぞれ32.7%,3.6%,19.1%であった。これらの実施の主な障壁として,マンパワーやPICSに関する知識,組織の理解,診療報酬があった。【結論】ICU退室後のフォローアップの実施率の低さが明らかになった。実施の推進のためには,ICUはもとより,あらゆる医療機能へのPICSに関する啓発強化,エビデンス蓄積の上,診療報酬の評価などを通した医療資源の確保が必要である。(著者抄録)
  • Kazuma Yamakawa, Ryo Yamamoto, Takero Terayama, Hideki Hashimoto, Tadashi Ishihara, Go Ishimaru, Haruki Imura, Hiromu Okano, Chihiro Narita, Takuya Mayumi, Hideto Yasuda, Kohei Yamada, Hiroyuki Yamada, Tatsuya Kawasaki, Nobuaki Shime, Kent Doi, Moritoki Egi, Hiroshi Ogura, Morio Aihara, Shigeki Kushimoto, Osamu Nishida
    Acute medicine & surgery 9(1) e789 2022年  
    BACKGROUND: Coronavirus disease (COVID-19), an infectious disease caused by the novel coronavirus severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has spread worldwide since early 2020, and there are still no signs of resolution. The Japanese Clinical Practice Guidelines for the Management of Sepsis and Septic Shock (J-SSCG) 2020 Special Committee created the Japanese Rapid/Living recommendations on drug management for COVID-19 using the experience of creating the J-SSCG. METHODS: The Grades of Recommendation, Assessment, Development, and Evaluation (GRADE) approach was used to determine the certainty of the evidence and strength of recommendations. The first edition of this guideline was released on September 9, 2020, and this is the revised edition (version 5.0; released on July 15, 2022). Clinical questions (CQs) were set for the following 10 drugs: favipiravir (CQ1), remdesivir (CQ2), corticosteroids (CQ4), tocilizumab (CQ5), anticoagulants (CQ7), baricitinib (CQ8), casirivimab/imdevimab (CQ9-1), sotrovimab (CQ9-2), molnupiravir (CQ10), and nirmatrelvir/ritonavir (CQ11). RECOMMENDATIONS: Favipiravir is not suggested for all patients with COVID-19 (GRADE 2C). Remdesivir is suggested for patients with mild COVID-19 who do not require oxygen, and patients with moderate COVID-19 requiring supplemental oxygen/hospitalization (both GRADE 2B). Corticosteroids are recommended for moderate and severe COVID-19 (GRADE 1B, 1A). However, their administration is not recommended for mild COVID-19 (GRADE 1B). Tocilizumab is suggested for moderate and severe COVID-19 (GRADE 2B, 2C). Anticoagulant administration is recommended for moderate and severe COVID-19 (Good Practice Statement). Baricitinib is suggested for moderate and severe COVID-19 (both GRADE 2C). Casirivimab/imdevimab and sotrovimab are recommended for mild COVID-19 (both GRADE 2C). Molnupiravir and nirmatrelvir/ritonavir are recommended for mild COVID-19 (both GRADE 2C). SARS-CoV-2 mutant strains emerge occasionally, and each time, the treatment policy at clinics is forced to change drastically. We ask health-care professionals in the field to refer to the recommendations in these guidelines and use these to keep up to date with COVID-19 epidemiological information.
  • Keibun Liu, Kensuke Nakamura, Hajime Katsukawa, Peter Nydahl, Eugene Wesley Ely, Sapna R. Kudchadkar, Kunihiko Takahashi, Muhammed Elhadi, Mohan Gurjar, Be Kim Leong, Chi Ryang Chung, Jayachandran Balachandran, Shigeaki Inoue, Alan Kawarai Lefor, Osamu Nishida
    Frontiers in Medicine 8 2021年10月28日  
    <bold>Background:</bold> Data regarding delivery of evidence-based care to critically ill patients in Intensive Care Units (ICU) during the COVID-19 pandemic is crucial but lacking. This study aimed to evaluate the implementation rate of the ABCDEF bundle, which is a collection of six evidence-based ICU care initiatives which are strongly recommended to be incorporated into clinical practice, and ICU diaries for patients with and without COVID-19 infections in ICUs, and to analyze the impact of COVID-19 on implementation of each element of the bundle and independent associated factors. <bold>Methods:</bold> A world-wide 1-day point prevalence study investigated the delivery of the ABCDEF bundle and ICU diary to patients without or with COVID-19 infections on 27 January 2021 <italic>via</italic> an online questionnaire. Multivariable logistic regression analysis with adjustment for patient demographics evaluated the impact of COVID-19 and identified factors in ICU administrative structures and policies independently associated with delivery. <bold>Results:</bold> From 54 countries and 135 ICUs, 1,229 patients were eligible, and 607 (49%) had COVID-19 infections. Implementation rates were: entire bundle (without COVID-19: 0% and with COVID-19: 1%), Element A (regular pain assessment: 64 and 55%), Element B (both spontaneous awakening and breathing trials: 17 and 10%), Element C (regular sedation assessment: 45 and 61%), Element D (regular delirium assessment: 39 and 35%), Element E (exercise: 22 and 25%), Element F (family engagement/empowerment: 16 and 30%), and ICU diary (17 and 21%). The presence of COVID-19 was not associated with failure to implement individual elements. Independently associated factors for each element in common between the two groups included presence of a specific written protocol, application of a target/goal, and tele-ICU management. A lower income status country and a 3:1 nurse-patient ratio were significantly associated with non-implementation of elements A, C, and D, while a lower income status country was also associated with implementation of element F. <bold>Conclusions:</bold> Regardless of COVID-19 infection status, implementation rates for the ABCDEF bundle, for each element individually and an ICU diary were extremely low for patients without and with COVID-19 infections during the pandemic. Strategies to facilitate implementation of and adherence to the complete ABCDEF bundle should be optimized and addressed based on unit-specific barriers and facilitators.
  • 飯田 有輝, 加藤 由布, 下村 泰代, 篠原 史都, 西田 修
    日本臨床生理学会雑誌 51(4) 61-61 2021年10月  
  • 黒田 泰弘, 則末 泰博, 鶴田 良介, 安田 英人, 江木 盛時, 小倉 裕司, 西田 修, 田中 裕, J-SSCG2020特別委員会
    日本集中治療医学会雑誌 28(Suppl.2) 187-187 2021年9月  
  • 西田 修, 小倉 裕司, 江木 盛時, 安宅 一晃, 井上 茂亮, 射場 敏明, 垣花 泰之, 川崎 達也, 久志本 成樹, 黒田 泰弘, 小谷 穣治, 志馬 伸朗, 谷口 巧, 鶴田 良介, 土井 研人, 土井 松幸, 中田 孝明, 中根 正樹, 藤島 清太郎, 細川 直登, 升田 好樹, 松嶋 麻子, 松田 直之, 矢田部 智昭, 田中 裕, J-SSCG2020特別委員会
    日本集中治療医学会雑誌 28(Suppl.2) 228-228 2021年9月  
  • 河合 佑亮, 西田 修, 飯田 有輝, 宇都宮 明美, 古薗 弘隆, 山田 亨, 吉田 悠平, 江木 盛時, 小倉 裕司, 安宅 一晃, 井上 茂亮, 射場 敏明, 垣花 泰之, 川崎 達也, 久志本 成樹, 黒田 泰弘, 小谷 穣治, 志馬 伸朗, 谷口 巧, 鶴田 良介, 土井 研人, 土井 松幸, 中田 孝明, 中根 正樹, 藤島 清太郎, 細川 直登, 升田 好樹, 松嶋 麻子, 松田 直之, 矢田部 智昭, 田中 裕, J-SSCG2020特別委員会Patient-and Family-Centered Care班
    日本集中治療医学会雑誌 28(Suppl.2) 229-229 2021年9月  
  • 河合 佑亮, 西田 修, 飯田 有輝, 宇都宮 明美, 古薗 弘隆, 山田 亨, 吉田 悠平, 江木 盛時, 小倉 裕司, 安宅 一晃, 井上 茂亮, 射場 敏明, 垣花 泰之, 川崎 達也, 久志本 成樹, 黒田 泰弘, 小谷 穣治, 志馬 伸朗, 谷口 巧, 鶴田 良介, 土井 研人, 土井 松幸, 中田 孝明, 中根 正樹, 藤島 清太郎, 細川 直登, 升田 好樹, 松嶋 麻子, 松田 直之, 矢田部 智昭, 田中 裕, J-SSCG2020特別委員会Patient-and Family-Centered Care班
    日本集中治療医学会雑誌 28(Suppl.2) 234-234 2021年9月  
  • 青木 善孝, 土井 松幸, 鶴田 良介, 櫻谷 正明, 鈴木 武志, 布宮 伸, 武田 親宗, 米倉 寛, 對東 俊介, 大内 玲, 櫻本 秀明, 金畑 圭太, 壽原 朋宏, 加藤 弘美, 藤村 直幸, 鈴木 佑二, 牧 盾, 柏浦 正広, 田中 裕記, 藤田 基, 金谷 明浩, 江木 盛時, 小倉 裕司, 西田 修, 田中 裕, J-SSCG2020特別委員会
    日本集中治療医学会雑誌 28(Suppl.2) 186-186 2021年9月  
  • 山川 一馬, 橋本 英樹, 寺山 毅郎, 江木 盛時, 小倉 裕司, 西田 修, 日本版敗血症診療ガイドライン2020特別委員会
    日本急性血液浄化学会雑誌 12(Suppl.) 63-63 2021年9月  
  • 河合 佑亮, 西田 修, 飯田 有輝, 宇都宮 明美, 古薗 弘隆, 山田 亨, 吉田 悠平, 江木 盛時, 小倉 裕司, 安宅 一晃, 井上 茂亮, 射場 敏明, 垣花 泰之, 川崎 達也, 久志本 成樹, 黒田 泰弘, 小谷 穣治, 志馬 伸朗, 谷口 巧, 鶴田 良介, 土井 研人, 土井 松幸, 中田 孝明, 中根 正樹, 藤島 清太郎, 細川 直登, 升田 好樹, 松嶋 麻子, 松田 直之, 矢田部 智昭, 田中 裕, J-SSCG2020特別委員会Patient-and Family-Centered Care班
    日本集中治療医学会雑誌 28(Suppl.2) 229-229 2021年9月  
  • 西田 修, 井上 茂亮, 山川 一馬, 畠山 淳司, 稲田 麻衣, 河合 佑亮, 飯田 有輝, 宇都宮 明美, 古薗 弘隆, 山田 亨, 吉田 悠平, 長澤 俊郎, 日本版敗血症診療ガイドライン2020特別委員会
    日本集中治療医学会雑誌 28(Suppl.2) 233-233 2021年9月  
  • 河合 佑亮, 西田 修, 飯田 有輝, 宇都宮 明美, 古薗 弘隆, 山田 亨, 吉田 悠平, 江木 盛時, 小倉 裕司, 安宅 一晃, 井上 茂亮, 射場 敏明, 垣花 泰之, 川崎 達也, 久志本 成樹, 黒田 泰弘, 小谷 穣治, 志馬 伸朗, 谷口 巧, 鶴田 良介, 土井 研人, 土井 松幸, 中田 孝明, 中根 正樹, 藤島 清太郎, 細川 直登, 升田 好樹, 松嶋 麻子, 松田 直之, 矢田部 智昭, 田中 裕, J-SSCG2020特別委員会Patient-and Family-Centered Care班
    日本集中治療医学会雑誌 28(Suppl.2) 234-234 2021年9月  
  • 山川 一馬, 橋本 英樹, 寺山 毅郎, 井村 春樹, 山元 良, 石原 唯史, 石丸 剛, 岡野 弘, 成田 知大, 真弓 卓也, 安田 英人, 山田 浩平, 山田 博之, 川崎 達也, 志馬 伸朗, 土井 研人, 江木 盛時, 小倉 裕司, 相原 守夫, 田中 裕, 西田 修, 日本版敗血症診療ガイドライン2020特別委員会COVID-19対策タスクフォース
    日本集中治療医学会雑誌 28(Suppl.2) 295-295 2021年9月  
  • 井村 春樹, 山川 一馬, 橋本 英樹, 寺山 毅郎, 山元 良, 石原 唯史, 石丸 剛, 岡野 弘, 成田 知大, 真弓 卓也, 安田 英人, 山田 浩平, 山田 博之, 川崎 達也, 志馬 伸朗, 土井 研人, 江木 盛時, 小倉 裕司, 相原 守夫, 田中 裕, 西田 修, 日本版敗血症診療ガイドライン2020特別委員会COVID-19対策タスクフォース
    日本集中治療医学会雑誌 28(Suppl.2) 295-295 2021年9月  
  • 寺山 毅郎, 山川 一馬, 橋本 英樹, 井村 春樹, 山元 良, 石原 唯史, 石丸 剛, 岡野 弘, 成田 知大, 真弓 卓也, 安田 英人, 山田 浩平, 山田 博之, 川崎 達也, 志馬 伸朗, 土井 研人, 江木 盛時, 小倉 裕司, 相原 守夫, 田中 裕, 西田 修, 日本版敗血症診療ガイドライン2020特別委員会COVID-19対策タスクフォース
    日本集中治療医学会雑誌 28(Suppl.2) 295-295 2021年9月  
  • 橋本 英樹, 山川 一馬, 寺山 毅郎, 井村 春樹, 山元 良, 石原 唯史, 石丸 剛, 岡野 弘, 成田 知大, 真弓 卓也, 安田 英人, 山田 浩平, 山田 博之, 川崎 達也, 志馬 伸朗, 土井 研人, 江木 盛時, 小倉 裕司, 相原 守夫, 田中 裕, 西田 修, 日本版敗血症診療ガイドライン2020特別委員会COVID-19対策タスクフォース
    日本集中治療医学会雑誌 28(Suppl.2) 296-296 2021年9月  
  • 山元 良, 山川 一馬, 橋本 英樹, 寺山 毅郎, 井村 春樹, 石原 唯史, 石丸 剛, 岡野 弘, 成田 知大, 真弓 卓也, 安田 英人, 山田 浩平, 山田 博之, 川崎 達也, 志馬 伸朗, 土井 研人, 江木 盛時, 小倉 裕司, 相原 守夫, 田中 裕, 西田 修, 日本版敗血症診療ガイドライン2020特別委員会COVID-19対策タスクフォース
    日本集中治療医学会雑誌 28(Suppl.2) 296-296 2021年9月  
  • Nobuto Nakanishi, Keibun Liu, Daisuke Kawakami, Yusuke Kawai, Tomoyuki Morisawa, Takeshi Nishida, Hidenori Sumita, Takeshi Unoki, Toru Hifumi, Yuki Iida, Hajime Katsukawa, Kensuke Nakamura, Shinichiro Ohshimo, Junji Hatakeyama, Shigeaki Inoue, Osamu Nishida
    Journal of clinical medicine 10(17) 2021年8月28日  
    Intensive care unit survivors experience prolonged physical impairments, cognitive impairments, and mental health problems, commonly referred to as post-intensive care syndrome (PICS). Previous studies reported the prevalence, assessment, and prevention of PICS, including the ABCDEF bundle approach. Although the management of PICS has been advanced, the outbreak of coronavirus disease 2019 (COVID-19) posed an additional challenge to PICS. The prevalence of PICS after COVID-19 extensively varied with 28-87% of cases pertaining to physical impairments, 20-57% pertaining to cognitive impairments, and 6-60% pertaining to mental health problems after 1-6 months after discharge. Each component of the ABCDEF bundle is not sufficiently provided from 16% to 52% owing to the highly transmissible nature of the virus. However, new data are emerging about analgesia, sedation, delirium care, nursing care, early mobilization, nutrition, and family support. In this review, we summarize the recent data on PICS and its new challenge in PICS after COVID-19 infection.
  • 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年8月25日  
    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.
  • Kazuhiro Moriyama, Osamu Nishida
    International journal of molecular sciences 22(16) 2021年8月18日  
    Sepsis is characterized by a dysregulated immune response to infections that causes life-threatening organ dysfunction and even death. When infections occur, bacterial cell wall components (endotoxin or lipopolysaccharide), known as pathogen-associated molecular patterns, bind to pattern recognition receptors, such as toll-like receptors, to initiate an inflammatory response for pathogen elimination. However, strong activation of the immune system leads to cellular dysfunction and ultimately organ failure. Damage-associated molecular patterns (DAMPs), which are released by injured host cells, are well-recognized triggers that result in the elevation of inflammatory cytokine levels. A cytokine storm is thus amplified and sustained in this vicious cycle. Interestingly, during sepsis, neutrophils transition from powerful antimicrobial protectors into dangerous mediators of tissue injury and organ dysfunction. Thus, the concept of blood purification has evolved to include inflammatory cells and mediators. In this review, we summarize recent advances in knowledge regarding the role of lipopolysaccharides, cytokines, DAMPs, and neutrophils in the pathogenesis of sepsis. Additionally, we discuss the potential of blood purification, especially the adsorption technology, for removing immune cells and molecular mediators, thereby serving as a therapeutic strategy against sepsis. Finally, we describe the concept of our immune-modulating blood purification system.
  • Yoshitaka Hara, Tomoaki Yatabe, Koshiro Kikkawa, Tomoyuki Nakamura, Naohide Kuriyama, Osamu Nishida
    Journal of artificial organs : the official journal of the Japanese Society for Artificial Organs 2021年8月16日  
    Infection during extracorporeal membrane oxygenation (ECMO) is a common complication that leads to increased mortality. Thus, antimicrobial prophylaxis during ECMO is often performed to prevent of nosocomial infections. However, the current status of antimicrobial prophylaxis during ECMO in Japan is unclear. Therefore, we conducted a national survey of members of the Japanese Society of Intensive Care Medicine (JSICM) to clarify the current status of antimicrobial prophylaxis during ECMO in intensive care units. An 11-question survey was devised to assess antimicrobial prophylaxis and surveillance practices during ECMO. A total of 253 hospitals responded. Of these, 235 hospitals were the JSICM-certified hospitals, and the response rate was 64%. A total of 96 hospitals (39%) administered antimicrobial prophylaxis during ECMO, and 17% of hospitals had a standardized protocol for antimicrobial prophylaxis during ECMO. Of these 96 hospitals, 79% used single agents. First-generation cephalosporins were the most commonly used (54%), followed by penicillins or penicillin-derived combinations (24%), second-generation cephalosporins (7%), and anti-methicillin-resistant Staphylococcus aureus agents (6%). In conclusion, our survey revealed 39% of hospitals administered antimicrobial prophylaxis during ECMO in Japan. First-generation cephalosporins were the agents most commonly used.
  • Takeshi Unoki, Yusuke Kawai, Miya Hamamoto, Mitsuhiro Tamoto, Takeharu Miyamoto, Hideaki Sakuramoto, Yumi Ito, Etsuko Moro, Junko Tatsuno, Osamu Nishida
    Healthcare (Basel, Switzerland) 9(8) 2021年8月7日  
    This study aimed to estimate the number of nurses who independently care for patients with severe respiratory failure receiving mechanical ventilation (MV) or veno-venous extracorporeal membrane oxygenation (VV-ECMO). Additionally, the study analyzed the actual role of nurses in the treatment of patients with MV and VV-ECMO. We performed a cross-sectional study using postal questionnaire surveys. The study included 725 Japanese intensive care units (ICUs). Data were analyzed using descriptive statistics. Among the 725 ICUs, we obtained 302 responses (41.7%) and analyzed 282 responses. The median number of nurses per bed was 3.25. The median proportion of nurses who independently cared for patients with MV was 60% (IQR: 42.3-77.3). The median proportion of nurses who independently cared for patients with VV-ECMO was 46.9 (35.7-63.3%) in the ICUs that had experience with VV-ECMO use. With regard to task-sharing, 33.8% of ICUs and nurses did not facilitate weaning from MV. Nurses always titrated sedative dosage in 44.5% of ICUs. Nurse staffing might be inadequate in all ICUs, especially for the management of patients with severe respiratory failure. The proportion of competent nurses to care for severe respiratory failure in ICUs should be considered when determining the workforce of nurses.
  • 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
    Acute Medicine & Surgery 2021年8月  最終著者
  • Shinya Suzuki, Kazuhiro Moriyama, Yoshitaka Hara, Takuya Hinoue, Yu Kato, Daisuke Hasegawa, Naohide Kuriyama, Tomoyuki Nakamura, Satoshi Komatsu, Chizuru Yamashita, Hidefumi Komura, Osamu Nishida
    Therapeutic apheresis and dialysis : official peer-reviewed journal of the International Society for Apheresis, the Japanese Society for Apheresis, the Japanese Society for Dialysis Therapy 25(4) 401-406 2021年8月  
    Myoglobin, which can cause acute kidney injury, has a relatively high molecular weight and is poorly cleared by diffusion. We compared and examined myoglobin clearance by changing the blood purification membrane and modality in patients with a myoglobin blood concentration ≥ 1000 ng/ml. We retrospectively analyzed three patient groups based on the following three types of continuous hemofiltration (CHF): AN69ST membrane, polymethylmethacrylate (PMMA) membrane, and high-flow hemodiafiltration (HDF) with increased dialysate flow rate using the PMMA membrane. There was no significant difference in clearance in CHF between AN69ST and PMMA membranes. However, the high-flow HDF group showed the highest myoglobin clearance (p = 0.003). In the PMMA membrane, changing the treatment modality to high-flow HDF increased clearance above the theoretical value, possibly due to internal filtration. To remove myoglobin by kidney replacement therapy from patients with hypermyoglobinemia, a modality such as high-flow HDF would be desirable.
  • Takuya Hinoue, Tomoaki Yatabe, Himuro Fujiwara, Osamu Nishida
    Journal of anesthesia 35(4) 586-590 2021年8月  
    The usefulness and safety of continuous glucose monitoring (CGM) systems in adult patients with severe coronavirus disease (COVID-19) have been reported. Using CGM might reduce the exposure patients and healthcare workers to COVID-19 and limit the use of personal protective equipment during the pandemic. CGM devices measure glucose in the subcutaneous interstitial fluid, but the accuracy of this technique has not been established in critically ill patients. The artificial pancreas, STG-55 (Nikkiso, Tokyo), is a closed-loop device that conducts continuous blood glucose monitoring using a peripheral vein. We used the STG-55 for glucose control in a 60-year-old woman with severe COVID-19 admitted to the intensive care unit. Due to severe respiratory failure, the patient was intubated, and extracorporeal membrane oxygenation was introduced. Because she had hyperglycemia despite high-dose intravenous insulin therapy, we decided to use STG-55 for glucose control. The STG-55 safely titrated the insulin infusion and monitored glucose levels. Fifty-six hours after adopting the STG-55, it was removed because the blood sampling failed. No episodes of hypoglycemia were observed despite deep sedation during this period. In conclusion, this case demonstrates the potential utility of an artificial pancreas in patients with severe COVID-19.
  • Takuya Hinoue, Isao Nahara, Tomoaki Yatabe, Yoshitaka Hara, Naohide Kuriyama, Tomoyuki Nakamura, Hidefumi Komura, Osamu Nishida
    Journal of cardiothoracic and vascular anesthesia 2021年7月8日  
    OBJECTIVES: Hyperchloremia is a potential risk factor for acute kidney injury (AKI) in critically ill patients. However, the relationship between hyperchloremia and postoperative AKI in adult patients undergoing cardiovascular surgery with cardiopulmonary bypass (CPB) remains unclear. The authors aimed to determine whether postoperative hyperchloremia was associated with postoperative AKI in these populations. OBJECTIVES: Retrospective, single-center study. SETTING: Tertiary care hospital. PARTICIPANTS: Adult patients who underwent cardiovascular surgery with CPB. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Patients with and without postoperative hyperchloremia were matched (1:1). The primary outcome was the rate of postoperative AKI diagnosed using the Kidney Disease: Improving Global Outcomes consensus criteria. Postoperative hyperchloremia was defined as postoperative serum chloride levels of >110 mmol/L during the first 48 hours. An increase in serum chloride levels (Δ[Cl-]) was defined as the difference between the preoperative and maximum postoperative serum chloride levels during the first 48 hours ([Cl-]max). Propensity-score matching and univariate and multivariate logistic regression analyses were employed. A total of 323 patients were included. Propensity-score matching selected 55 pairs for the final comparison. The incidence of postoperative AKI did not differ between the two groups (47% v 46%, p = 1.0). In the multivariate logistic regression analysis, Δ[Cl-] was associated independently with the development of postoperative AKI (odds ratio, 1.13; 95% confidence interval, 1.06-1.21; p < 0.001). CONCLUSIONS: Exposure to postoperative hyperchloremia was not associated with postoperative AKI in adult patients undergoing cardiovascular surgery with CPB. However, an increase in the serum chloride level might be associated with postoperative AKI.
  • 森山和広, 西田修
    腎臓内科 14(1) 98-106 2021年7月  
  • Miya Hamamoto, Takeshi Unoki, Mitsuhiro Tamoto, Hideaki Sakuramoto, Yusuke Kawai, Takeharu Miyamoto, Yumi Ito, Etsuko Moro, Junko Tatsuno, Osamu Nishida
    Japan journal of nursing science : JJNS e12424 2021年6月3日  
    Determining the number of nurses required for patients with coronavirus disease receiving mechanical ventilation and/or veno-veno extracorporeal membrane oxygenation is important to provide quality care. Therefore, we conducted this cross-sectional survey of 725 intensive care units in Japan. Data from 152 units with experience of managing patients with coronavirus disease who required tracheal intubation were analyzed. The median number of nurses required for a patient receiving mechanical ventilation or veno-veno extracorporeal membrane oxygenation was two. This number was more than that according to the Japanese standard determined by government. We conclude that more nursing staff is required for caring for patients critically ill with coronavirus disease in intensive care units.
  • Yoshitaka Hara, Tomoaki Yatabe, Satoshi Komatsu, Naohide Kuriyama, Tomoyuki Nakamura, Chizuru Yamashita, Hidefumi Komura, Osamu Nishida
    Journal of artificial organs : the official journal of the Japanese Society for Artificial Organs 24(2) 282-286 2021年6月  
    Spontaneous abdominal wall hematomas are relatively rare and mainly attributed to anticoagulation and severe cough. Despite the high incidence of anticoagulation-related bleeding complications, there are no reports of spontaneous abdominal wall hematomas during extracorporeal membrane oxygenation (ECMO). We report a case of a spontaneous rectus sheath hematoma caused by alternation of the lateral semi-prone position during ECMO in a 76-year-old female patient with severe acute respiratory distress syndrome. Unfractionated heparin 12,000-14,000 units/day was administered for anticoagulation during ECMO. From Day 6 of ECMO, the patient who was under deep sedation was alternately placed in the left and right lateral semi-prone positions every 4 h, for approximately 20 h per day. On Day 12 of ECMO, the patient developed hypotension with anemia and a palpable mass in the right lower abdomen. Abdominal ultrasonographic imaging revealed a huge echo-free space centered in the right lower abdomen. Emergency contrast-enhanced computed tomography (CT) scanning showed extravasation from the superior and inferior epigastric arteries as well as a rectus sheath hematoma. Despite no apparent contrast leakage, an inferior epigastric artery embolization was undertaken because the patient was on ECMO. On Day 13 after ECMO initiation, ECMO and anticoagulation were discontinued. On CT scanning a week later, the hematoma had reduced. In conclusion, spontaneous abdominal wall hematoma is a rare and important complication that might occur during ECMO. Thus, careful physical examination should be routinely conducted when the patient is semi-prone during ECMO.
  • Daisuke Hasegawa, Ryota Sato, Narut Prasitlumkum, Kazuki Nishida, Kunihiko Takahashi, Tomoaki Yatabe, Osamu Nishida
    Chest 159(6) 2289-2300 2021年6月  
    BACKGROUND: Historically, β-blockers have been considered to be relatively contraindicated for septic shock because they may cause cardiac suppression. On the other hand, there is an increasing interest in the use of β-blockers for treating patients with sepsis with persistent tachycardia despite initial resuscitation. RESEARCH QUESTION: Do ultrashort-acting β-blockers such as esmolol and landiolol improve mortality in patients with sepsis with persistent tachycardia despite initial resuscitation? STUDY DESIGN AND METHODS: This was a systematic review and meta-analysis. We searched MEDLINE, Cochrane Central Register of Controlled Trials, and Embase for randomized controlled trials (RCTs) that compared the mortality of patients with sepsis and septic shock treated with esmolol or landiolol. We updated our search on April 20, 2020. Two independent reviewers assessed whether titles and abstracts met the following eligibility criteria: (1) RCT, (2) patients with sepsis and septic shock ≥ 18 years of age, and (3) treatment with either esmolol/landiolol or placebo/no interventions. Two authors independently extracted selected patient and study characteristics and outcomes. The results of all analyses are presented using random effect models. RESULTS: Seven RCTs with a pooled sample size of 613 patients were included. Of these, six RCTs with 572 patients reported 28-day mortality. Esmolol or landiolol use in patients with sepsis and septic shock was significantly associated with lower 28-day mortality (risk ratio, 0.68; 95% CI, 0.54-0.85; P < .001). Unimportant heterogeneity was observed (I2 = 31%). The absolute risk reduction and number of patients to be treated to prevent one death were 18.2% and 5.5, respectively. INTERPRETATION: The use of ultrashort-acting β-blockers such as esmolol and landiolol in patients with sepsis with persistent tachycardia despite initial resuscitation was associated with significantly lower 28-day mortality. TRIAL REGISTRY: UMIN Clinical Trials Registry; No.: UMIN000040174; URL: https://www.umin.ac.jp/ctr/index.htm.
  • 西田修, 森山和広
    日本内科学会雑誌 110(5) 942-948 2021年5月10日  査読有り
  • Daisuke Hasegawa, Ryota Sato, Osamu Nishida
    Journal of intensive care 9(1) 39-39 2021年5月8日  
    BACKGROUND: The use of ultrashort-acting β1-blockers recently has attracted attention in septic patients with non-compensatory tachycardia. We summarized the metabolic and hemodynamic effects and the clinical evidence of ultrashort-acting β1-blockers. MAIN BODY: A recent meta-analysis showed that ultrashort-acting β1-blockers reduced the mortality in septic patients with persistent tachycardia. However, its mechanism to improve mortality is not fully understood yet. We often use lactate as a marker of oxygen delivery, but an impaired oxygen use rather than reduced oxygen delivery has been recently proposed as a more reasonable explanation of hyperlactatemia in patients with sepsis, leading to a question of whether β1-blockers affect metabolic systems. While the stimulation of the β2-receptor accelerates glycolysis and lactate production, the role of β1-blocker in lactate production remains unclear and studies investigating the role of β1-blockers in lactate kinetics are warranted. A meta-analysis also reported that ultrashort-acting β1-blockers increased stroke volume index, while it reduced heart rate, resulting in unchanged cardiac index, mean arterial pressure, and norepinephrine requirement at 24 h, leading to an improvement of cardiovascular efficiency. On the other hand, a recent study reported that heart rate reduction using fast esmolol titration in the very early phase of septic shock caused hemodynamic instability, suggesting that ultrashort-acting β1-blockers should be started only after completing initial resuscitation. While many clinicians still do not feel comfortable controlling sinus tachycardia, one randomized controlled trial in which the majority had sinus tachycardia suggested the mortality benefit of ultrashort-acting β1-blockers. Therefore, it still deems to be reasonable to control sinus tachycardia with ultrashort-acting β1-blockers after completing initial resuscitation. CONCLUSION: Accumulating evidence is supporting the use of ultrashort-acting β1-blockers while larger randomized controlled trials to clarify the effect of ultrashort-acting β1-blockers are still warranted.
  • Yu Kato, Osamu Nishida, Naohide Kuriyama, Tomoyuki Nakamura, Takahiro Kawaji, Takanori Onouchi, Daisuke Hasegawa, Yasuyo Shimomura
    International journal of molecular sciences 22(9) 2021年5月6日  
    Neutrophil extracellular trap (NET) formation, an innate immune system response, is associated with thrombogenesis and vascular endothelial injury. Circulatory disorders due to microvascular thrombogenesis are one of the principal causes of organ damage. NET formation in organs contributes to the exacerbation of sepsis, which is defined as a life-threatening organ dysfunction caused by a dysregulated host response to infection. We have previously reported that recombinant human soluble thrombomodulin (rTM) reduces lipopolysaccharide (LPS)-induced NET formation in vitro. Here, we aimed to show that thrombomodulin (TM)-mediated suppression of NET formation protects against organ damage in sepsis. Mice were injected intraperitoneally (i.p.) with 10 mg/kg LPS. rTM (6 mg/kg/day) or saline was administered i.p. 1 h after LPS injection. In the LPS-induced murine septic shock model, extracellular histones, which are components of NETs, were observed in the liver and lungs. In addition, the serum cytokine (interleukin-1β (IL-1β), interleukin-6 (IL-6), tumor necrosis factor-α (TNF-α), macrophage chemotactic protein-1 (MCP-1), and interleukin-10 (IL-10)) levels were increased. The administration of rTM in this model prevented NET formation in the organs and suppressed the increase in the levels of all cytokines except IL-1β. Furthermore, the survival rate improved. We provide a novel role of TM in treating inflammation and NETs in organs during sepsis.
  • Kazuma Yamakawa, Ryo Yamamoto, Go Ishimaru, Hideki Hashimoto, Takero Terayama, Yoshitaka Hara, Daisuke Hasegawa, Tadashi Ishihara, Haruki Imura, Hiromu Okano, Chihiro Narita, Takuya Mayumi, Hideto Yasuda, Kohei Yamada, Hiroyuki Yamada, Tatsuya Kawasaki, Nobuaki Shime, Kent Doi, Moritoki Egi, Hiroshi Ogura, Morio Aihara, Hiroshi Tanaka, Osamu Nishida
    Acute medicine & surgery 8(1) e664 2021年5月4日  
    The Coronavirus disease 2019 (COVID-19) has spread worldwide since early 2020, and there are still no signs of resolution. The Japanese Clinical Practice Guidelines for the Management of Sepsis and Septic Shock (J-SSCG) 2020 Special Committee created the Japanese Rapid/Living recommendations on drug management for COVID-19 using the experience of creating the J-SSCGs. The Grades of Recommendation, Assessment, Development, and Evaluation (GRADE) approach was used to determine the certainty of the evidence and strength of the recommendations. The first edition of this guideline was released on September 9, 2020, and this document is the revised edition (ver. 3.1) (released on March 30, 2021). Clinical questions (CQs) were set for the following seven drugs: favipiravir (CQ1), remdesivir (CQ-2), hydroxychloroquine (CQ-3), corticosteroids (CQ-4), tocilizumab (CQ-5), ciclesonide (CQ-6), and anticoagulants (CQ-7). Favipiravir is recommended for patients with mild COVID-19 not requiring supplemental oxygen (GRADE 2C); remdesivir for moderate COVID-19 patients requiring supplemental oxygen/hospitalization (GRADE 2B); hydroxychloroquine is not recommended for all COVID-19 patients (GRADE 1B); corticosteroids are recommended for moderate COVID-19 patients requiring supplemental oxygen/hospitalization (GRADE 1B) and severe COVID-19 patients requiring ventilator management/intensive care (GRADE 1A); however, their administration is not recommended for mild COVID-19 patients not requiring supplemental oxygen (GRADE 1B); tocilizumab is recommended for moderate COVID-19 patients requiring supplemental oxygen/hospitalization (GRADE 2B); and anticoagulant therapy for moderate COVID-19 patients requiring supplemental oxygen/hospitalization and severe COVID-19 patients requiring ventilator management/intensive care (GRADE 2C). We hope that these clinical practice guidelines will aid medical professionals involved in the care of COVID-19 patients.
  • 飯田 有輝, 篠原 史都, 村松 恵多, 河合 佑亮, 柴田 斉子, 大高 洋平, 西田 修
    The Japanese Journal of Rehabilitation Medicine 58(特別号) JSY33-3 2021年5月  
  • 内山壮太, 伊藤貴志, 樋上拓哉, 見須有祐, 村山誠弥, 原嘉孝, 栗山直英, 西田修
    ICUとCCU 45(5) 313-317 2021年5月  

MISC

 164
  • 橋本 英樹, 山川 一馬, 寺山 毅郎, 井村 春樹, 山元 良, 石原 唯史, 石丸 剛, 岡野 弘, 成田 知大, 真弓 卓也, 安田 英人, 山田 浩平, 山田 博之, 川崎 達也, 志馬 伸朗, 土井 研人, 江木 盛時, 小倉 裕司, 相原 守夫, 田中 裕, 西田 修, 日本版敗血症診療ガイドライン2020特別委員会COVID-19対策タスクフォース
    日本集中治療医学会雑誌 28(Suppl.2) 296-296 2021年9月  
  • 山元 良, 山川 一馬, 橋本 英樹, 寺山 毅郎, 井村 春樹, 石原 唯史, 石丸 剛, 岡野 弘, 成田 知大, 真弓 卓也, 安田 英人, 山田 浩平, 山田 博之, 川崎 達也, 志馬 伸朗, 土井 研人, 江木 盛時, 小倉 裕司, 相原 守夫, 田中 裕, 西田 修, 日本版敗血症診療ガイドライン2020特別委員会COVID-19対策タスクフォース
    日本集中治療医学会雑誌 28(Suppl.2) 296-296 2021年9月  
  • 江木 盛時, 小倉 裕司, 矢田部 智昭, 安宅 一晃, 井上 茂亮, 射場 敏明, 垣花 泰之, 川崎 達也, 久志本 成樹, 黒田 泰弘, 小谷 穣治, 志馬 伸朗, 谷口 巧, 鶴田 良介, 土井 研人, 土井 松幸, 中田 孝明, 中根 正樹, 藤島 清太郎, 細川 直登, 升田 好樹, 松嶋 麻子, 松田 直之, 山川 一馬, 原 嘉孝, 大下 慎一郎, 青木 善孝, 稲田 麻衣, 梅村 穣, 河合 佑亮, 近藤 豊, 斎藤 浩輝, 櫻谷 正明, 對東 俊介, 武田 親宗, 寺山 毅郎, 東平 日出夫, 橋本 英樹, 林田 敬, 一二三 亨, 廣瀬 智也, 福田 龍将, 藤井 智子, 三浦 慎也, 安田 英人, 阿部 智一, 安藤 幸吉, 飯田 有輝, 石原 唯史, 井手 健太郎, 伊藤 健太, 伊藤 雄介, 稲田 雄, 宇都宮 明美, 卯野木 健, 遠藤 功二, 大内 玲, 尾崎 将之, 小野 聡, 桂 守弘, 川口 敦, 川村 雄介, 工藤 大介, 久保 健児, 倉橋 清泰, 櫻本 秀明, 下山 哲, 鈴木 武志, 関根 秀介, 関野 元裕, 高橋 希, 高橋 世, 高橋 弘, 田上 隆, 田島 吾郎, 巽 博臣, 谷 昌憲, 土谷 飛鳥, 堤 悠介, 内藤 貴基, 長江 正晴, 長澤 俊郎, 中村 謙介, 西村 哲郎, 布宮 伸, 則末 泰博, 橋本 悟, 長谷川 大祐, 畠山 淳司, 原 直己, 東別府 直紀, 古島 夏奈, 古薗 弘隆, 松石 雄二朗, 松山 匡, 峰松 佑輔, 宮下 亮一, 宮武 祐士, 森安 恵実, 山田 亨, 山田 博之, 山元 良, 吉田 健史, 吉田 悠平, 吉村 旬平, 四本 竜一, 米倉 寛, 和田 剛志, 渡邉 栄三, 青木 誠, 浅井 英樹, 安部 隆国, 五十嵐 豊, 井口 直也, 石川 雅巳, 石丸 剛, 磯川 修太郎, 板倉 隆太, 今長谷 尚史, 井村 春樹, 入野田 崇, 上原 健司, 生塩 典敬, 梅垣 岳志, 江川 裕子, 榎本 有希, 太田 浩平, 大地 嘉史, 大野 孝則, 大邉 寛幸, 岡 和幸, 岡田 信長, 岡田 遥平, 岡野 弘, 岡本 潤, 奥田 拓史, 小倉 崇以, 小野寺 悠, 小山 雄太, 貝沼 関志, 加古 英介, 柏浦 正広, 加藤 弘美, 金谷 明浩, 金子 唯, 金畑 圭太, 狩野 謙一, 河野 浩幸, 菊谷 知也, 菊地 斉, 城戸 崇裕, 木村 翔, 小網 博之, 小橋 大輔, 齊木 巌, 堺 正仁, 坂本 彩香, 佐藤 哲哉, 志賀 康浩, 下戸 学, 下山 伸哉, 庄古 知久, 菅原 陽, 杉田 篤紀, 鈴木 聡, 鈴木 祐二, 壽原 朋宏, 其田 健司, 高氏 修平, 高島 光平, 高橋 生, 高橋 洋子, 竹下 淳, 田中 裕記, 丹保 亜希仁, 角山 泰一朗, 鉄原 健一, 徳永 健太郎, 富岡 義裕, 冨田 健太朗, 富永 直樹, 豊崎 光信, 豊田 幸樹年, 内藤 宏道, 永田 功, 長門 直, 中村 嘉, 中森 裕毅, 名原 功, 奈良場 啓, 成田 知大, 西岡 典宏, 西村 朋也, 西山 慶, 野村 智久, 芳賀 大樹, 萩原 祥弘, 橋本 克彦, 旗智 武志, 浜崎 俊明, 林 拓也, 林 実, 速水 宏樹, 原口 剛, 平野 洋平, 藤井 遼, 藤田 基, 藤村 直幸, 舩越 拓, 堀口 真仁, 牧 盾, 増永 直久, 松村 洋輔, 真弓 卓也, 南 啓介, 宮崎 裕也, 宮本 和幸, 村田 哲平, 柳井 真知, 矢野 隆郎, 山田 浩平, 山田 直樹, 山本 朋納, 吉廣 尚大, 田中 裕, 西田 修, 日本版敗血症診療ガイドライン2020特別委員会
    日本救急医学会雑誌 32(S1) S1-S411 2021年2月  
    日本集中治療医学会と日本救急医学会は,合同の特別委員会を組織し,2016年に発表した日本版敗血症診療ガイドライン(J-SSCG)2016の改訂を行った。本ガイドライン(J-SSCG2020)の目的は,J-SSCG2016と同様に,敗血症・敗血症性ショックの診療において,医療従事者が患者の予後改善のために適切な判断を下す支援を行うことである。改訂に際し,一般臨床家だけでなく多職種医療者にも理解しやすく,かつ質の高いガイドラインとすることによって,広い普及を目指した。J-SSCG2016ではSSCG2016にない新しい領域[ICU-acquircd weakness(ICU-AW)とpost-intensive care syndrome(POCS),体温管理など]を取り上げたが,J-SSCG2020では新たに注目すべき4領域(Patient-and Family-Centered Care, sepsis treatment system,神経集中治療,ストレス潰瘍)を追加し,計22領域とした。重要な118の臨床課題(clinical question:CQ)をエビデンスの有無にかかわらず抽出した。これらのCQには,本邦で特に注目されているCQも含まれる。多領域にわたる大規模ガイドラインであることから,委員25名を中心に,多職種(看護師,理学療法士,臨床工学技士,薬剤師)および患者経験者も含めたワーキンググループメンバー,両学会の公募によるシステマティックレビューメンバーによる総勢226名の参加・協力を得た。また,中立的な立場で横断的に活躍するアカデミックガイドライン推進班をJ-SSCG2016に引き続き組織した。将来への橋渡しとなることを企図して,多くの若手医師をシステマティックレビューチーム・ワーキンググループに登用し,学会や施設の垣根を越えたネットワーク構築も進めた。作成工程においては,質の担保と作業過程の透明化を図るために様々な工夫を行い,パブリックコメント募集は計2回行った。推奨作成にはGRADE方式を取り入れ,修正Delphi法を用いて全委員の投票により推奨を決定した。結果,118CQに対する回答として,79個のGRADEによる推奨,5個のGPS(good practice statement),18個のエキスパートコンセンサス,27個のBQ(background question)の解説,および敗血症の定義と診断を示した。新たな試みとして,CQごとに診療フローなど時間軸に沿った視覚的情報を取り入れた。J-SSCG2020は,多職種が関わる国内外の敗血症診療の現場において,ベッドサイドで役立つガイドラインとして広く活用されることが期待される。なお,本ガイドラインは,日本集中治療医学会と日本救急医学会の両機関誌のガイドライン増刊号として同時掲載するものである。(著者抄録)
  • 江木 盛時, 小倉 裕司, 矢田部 智昭, 安宅 一晃, 井上 茂亮, 射場 敏明, 垣花 泰之, 川崎 達也, 久志本 成樹, 黒田 泰弘, 小谷 穣治, 志馬 伸朗, 谷口 巧, 鶴田 良介, 土井 研人, 土井 松幸, 中田 孝明, 中根 正樹, 藤島 清太郎, 細川 直登, 升田 好樹, 松嶋 麻子, 松田 直之, 山川 一馬, 原 嘉孝, 大下 慎一郎, 青木 善孝, 稲田 麻衣, 梅村 穣, 河合 佑亮, 近藤 豊, 斎藤 浩輝, 櫻谷 正明, 對東 俊介, 武田 親宗, 寺山 毅郎, 東平 日出夫, 橋本 英樹, 林田 敬, 一二三 亨, 廣瀬 智也, 福田 龍将, 藤井 智子, 三浦 慎也, 安田 英人, 阿部 智一, 安藤 幸吉, 飯田 有輝, 石原 唯史, 井手 健太郎, 伊藤 健太, 伊藤 雄介, 稲田 雄, 宇都宮 明美, 卯野木 健, 遠藤 功二, 大内 玲, 尾崎 将之, 小野 聡, 桂 守弘, 川口 敦, 川村 雄介, 工藤 大介, 久保 健児, 倉橋 清泰, 櫻本 秀明, 下山 哲, 鈴木 武志, 関根 秀介, 関野 元裕, 高橋 希, 高橋 世, 高橋 弘, 田上 隆, 田島 吾郎, 巽 博臣, 谷 昌憲, 土谷 飛鳥, 堤 悠介, 内藤 貴基, 長江 正晴, 長澤 俊郎, 中村 謙介, 西村 哲郎, 布宮 伸, 則末 泰博, 橋本 悟, 長谷川 大祐, 畠山 淳司, 原 直己, 東別府 直紀, 古島 夏奈, 古薗 弘隆, 松石 雄二朗, 松山 匡, 峰松 佑輔, 宮下 亮一, 宮武 祐士, 森安 恵実, 山田 亨, 山田 博之, 山元 良, 吉田 健史, 吉田 悠平, 吉村 旬平, 四本 竜一, 米倉 寛, 和田 剛志, 渡邉 栄三, 青木 誠, 浅井 英樹, 安部 隆国, 五十嵐 豊, 井口 直也, 石川 雅巳, 石丸 剛, 磯川 修太郎, 板倉 隆太, 今長谷 尚史, 井村 春樹, 入野田 崇, 上原 健司, 生塩 典敬, 梅垣 岳志, 江川 裕子, 榎本 有希, 太田 浩平, 大地 嘉史, 大野 孝則, 大邉 寛幸, 岡 和幸, 岡田 信長, 岡田 遥平, 岡野 弘, 岡本 潤, 奥田 拓史, 小倉 崇以, 小野寺 悠, 小山 雄太, 貝沼 関志, 加古 英介, 柏浦 正広, 加藤 弘美, 金谷 明浩, 金子 唯, 金畑 圭太, 狩野 謙一, 河野 浩幸, 菊谷 知也, 菊地 斉, 城戸 崇裕, 木村 翔, 小網 博之, 小橋 大輔, 齊木 巌, 堺 正仁, 坂本 彩香, 佐藤 哲哉, 志賀 康浩, 下戸 学, 下山 伸哉, 庄古 知久, 菅原 陽, 杉田 篤紀, 鈴木 聡, 鈴木 祐二, 壽原 朋宏, 其田 健司, 高氏 修平, 高島 光平, 高橋 生, 高橋 洋子, 竹下 淳, 田中 裕記, 丹保 亜希仁, 角山 泰一朗, 鉄原 健一, 徳永 健太郎, 富岡 義裕, 冨田 健太朗, 富永 直樹, 豊崎 光信, 豊田 幸樹年, 内藤 宏道, 永田 功, 長門 直, 中村 嘉, 中森 裕毅, 名原 功, 奈良場 啓, 成田 知大, 西岡 典宏, 西村 朋也, 西山 慶, 野村 智久, 芳賀 大樹, 萩原 祥弘, 橋本 克彦, 旗智 武志, 浜崎 俊明, 林 拓也, 林 実, 速水 宏樹, 原口 剛, 平野 洋平, 藤井 遼, 藤田 基, 藤村 直幸, 舩越 拓, 堀口 真仁, 牧 盾, 増永 直久, 松村 洋輔, 真弓 卓也, 南 啓介, 宮崎 裕也, 宮本 和幸, 村田 哲平, 柳井 真知, 矢野 隆郎, 山田 浩平, 山田 直樹, 山本 朋納, 吉廣 尚大, 田中 裕, 西田 修, 日本版敗血症診療ガイドライン2020特別委員会
    日本集中治療医学会雑誌 28(Suppl.) S1-S411 2021年2月  
    日本集中治療医学会と日本救急医学会は,合同の特別委員会を組織し,2016年に発表した日本版敗血症診療ガイドライン(J-SSCG)2016の改訂を行った。本ガイドライン(J-SSCG2020)の目的は,J-SSCG2016と同様に,敗血症・敗血症性ショックの診療において,医療従事者が患者の予後改善のために適切な判断を下す支援を行うことである。改訂に際し,一般臨床家だけでなく多職種医療者にも理解しやすく,かつ質の高いガイドラインとすることによって,広い普及を目指した。J-SSCG2016ではSSCG2016にない新しい領域[ICU-acquircd weakness(ICU-AW)とpost-intensive care syndrome(POCS),体温管理など]を取り上げたが,J-SSCG2020では新たに注目すべき4領域(Patient-and Family-Centered Care, sepsis treatment system,神経集中治療,ストレス潰瘍)を追加し,計22領域とした。重要な118の臨床課題(clinical question:CQ)をエビデンスの有無にかかわらず抽出した。これらのCQには,本邦で特に注目されているCQも含まれる。多領域にわたる大規模ガイドラインであることから,委員25名を中心に,多職種(看護師,理学療法士,臨床工学技士,薬剤師)および患者経験者も含めたワーキンググループメンバー,両学会の公募によるシステマティックレビューメンバーによる総勢226名の参加・協力を得た。また,中立的な立場で横断的に活躍するアカデミックガイドライン推進班をJ-SSCG2016に引き続き組織した。将来への橋渡しとなることを企図して,多くの若手医師をシステマティックレビューチーム・ワーキンググループに登用し,学会や施設の垣根を越えたネットワーク構築も進めた。作成工程においては,質の担保と作業過程の透明化を図るために様々な工夫を行い,パブリックコメント募集は計2回行った。推奨作成にはGRADE方式を取り入れ,修正Delphi法を用いて全委員の投票により推奨を決定した。結果,118CQに対する回答として,79個のGRADEによる推奨,5個のGPS(good practice statement),18個のエキスパートコンセンサス,27個のBQ(background question)の解説,および敗血症の定義と診断を示した。新たな試みとして,CQごとに診療フローなど時間軸に沿った視覚的情報を取り入れた。J-SSCG2020は,多職種が関わる国内外の敗血症診療の現場において,ベッドサイドで役立つガイドラインとして広く活用されることが期待される。なお,本ガイドラインは,日本集中治療医学会と日本救急医学会の両機関誌のガイドライン増刊号として同時掲載するものである。(著者抄録)
  • 伊藤翔太, 篠原史都, 水谷公司, 加賀谷斉, 幸村英文, 西田修
    日本集中治療医学会学術集会(Web) 48th 2021年  
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