基本情報
- 所属
- 自治医科大学 医学部 総合医学第2講座 講師
- 学位
- 博士(医学)(2019年3月 自治医科大学)
- J-GLOBAL ID
- 201501084186937931
- researchmap会員ID
- B000245937
研究分野
1経歴
3-
2024年4月 - 現在
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2019年6月 - 現在
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2019年3月 - 現在
学歴
1-
2015年4月 - 2019年3月
委員歴
7-
2024年3月 - 現在
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2023年1月 - 現在
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2022年8月 - 現在
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2022年4月 - 現在
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2020年10月 - 現在
受賞
5論文
63-
Intensive care medicine 2024年9月23日
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Scientific reports 14(1) 14477-14477 2024年6月24日Normally aerated lung tissue on computed tomography (CT) is correlated with static respiratory system compliance (Crs) at zero end-expiratory pressure. In clinical practice, however, patients with acute respiratory failure are often managed using elevated PEEP levels. No study has validated the relationship between lung volume and tissue and Crs at the applied positive end-expiratory pressure (PEEP). Therefore, this study aimed to demonstrate the relationship between lung volume and tissue on CT and Crs during the application of PEEP for the clinical management of patients with acute respiratory distress syndrome due to COVID-19. Additionally, as a secondary outcome, the study aimed to evaluate the relationship between CT characteristics and Crs, considering recruitability using the recruitment-to-inflation ratio (R/I ratio). We analyzed the CT and respiratory mechanics data of 30 patients with COVID-19 who were mechanically ventilated. The CT images were acquired during mechanical ventilation at PEEP level of 15 cmH2O and were quantitatively analyzed using Synapse Vincent system version 6.4 (Fujifilm Corporation, Tokyo, Japan). Recruitability was stratified into two groups, high and low recruitability, based on the median R/I ratio of our study population. Thirty patients were included in the analysis with the median R/I ratio of 0.71. A significant correlation was observed between Crs at the applied PEEP (median 15 [interquartile range (IQR) 12.2, 15.8]) and the normally aerated lung volume (r = 0.70 [95% CI 0.46-0.85], P < 0.001) and tissue (r = 0.70 [95% CI 0.46-0.85], P < 0.001). Multivariable linear regression revealed that recruitability (Coefficient = - 390.9 [95% CI - 725.0 to - 56.8], P = 0.024) and Crs (Coefficient = 48.9 [95% CI 32.6-65.2], P < 0.001) were significantly associated with normally aerated lung volume (R-squared: 0.58). In this study, Crs at the applied PEEP was significantly correlated with normally aerated lung volume and tissue on CT. Moreover, recruitability indicated by the R/I ratio and Crs were significantly associated with the normally aerated lung volume. This research underscores the significance of Crs at the applied PEEP as a bedside-measurable parameter and sheds new light on the link between recruitability and normally aerated lung.
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Microbiology spectrum e0034224 2024年6月12日Whether empirical therapy with carbapenems positively affects the outcomes of critically ill patients with bacterial infections remains unclear. This study aimed to investigate whether the use of carbapenems as the initial antimicrobial administration reduces mortality and whether the duration of carbapenem use affects the detection of multidrug-resistant (MDR) pathogens. This was a post hoc analysis of data acquired from Japanese participating sites from a multicenter, prospective observational study [Determinants of Antimicrobial Use and De-escalation in Critical Care (DIANA study)]. A total of 268 adult patients with clinically suspected or confirmed bacterial infections from 31 Japanese intensive care units (ICUs) were analyzed. The patients were divided into two groups: patients who were administered carbapenems as initial antimicrobials (initial carbapenem group, n = 99) and those who were not administered carbapenems (initial non-carbapenem group, n = 169). The primary outcomes were mortality at day 28 and detection of MDR pathogens. Multivariate logistic regression analysis revealed that mortality at day 28 did not differ between the two groups [18 (18%) vs 27 (16%), respectively; odds ratio: 1.25 (95% confidence interval (CI): 0.59-2.65), P = 0.564]. The subdistribution hazard ratio for detecting MDR pathogens on day 28 per additional day of carbapenem use is 1.08 (95% CI: 1.05-1.13, P < 0.001 using the Fine-Gray model with death regarded as a competing event). In conclusion, in-hospital mortality was similar between the groups, and a longer duration of carbapenem use as the initial antimicrobial therapy resulted in a higher risk of detection of new MDR pathogens.IMPORTANCEWe found no statistical difference in mortality with the empirical use of carbapenems as initial antimicrobial therapy among critically ill patients with bacterial infections. Our study revealed a lower proportion of inappropriate initial antimicrobial administrations than those reported in previous studies. This result suggests the importance of appropriate risk assessment for the involvement of multidrug-resistant (MDR) pathogens and the selection of suitable antibiotics based on risk. To the best of our knowledge, this study is the first to demonstrate that a longer duration of carbapenem use as initial therapy is associated with a higher risk of subsequent detection of MDR pathogens. This finding underscores the importance of efforts to minimize the duration of carbapenem use as initial antimicrobial therapy when it is necessary.
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Journal of anesthesia, analgesia and critical care 4(1) 23-23 2024年4月3日BACKGROUND: Sepsis-3 emphasizes the recognition of sepsis-induced cellular metabolic abnormalities, and utilizes serum lactate level as a biomarker of cellular metabolic abnormalities. Magnesium plays an important role as a cofactor in glucose metabolism, although it is not well known that magnesium deficiency causes elevated serum lactate levels. Additionally, it remains unclear how magnesium status affects the role of serum lactate levels as a marker of metabolic abnormalities in sepsis. Thus, this study aimed to investigate the association between serum magnesium and lactate levels in patients with sepsis and explore this relationship from the perspectives of time course and circulatory abnormalities. METHODS: This retrospective observational study of adult patients with sepsis was performed at the 16-bed intensive care unit of Jichi Medical University Hospital between June 2011 and December 2017. The relationship between serum magnesium and lactate levels for 5 days from intensive care unit admission was investigated along the time course. Multivariate logistic regression analysis was performed to evaluate the association between serum magnesium and lactate levels during intensive care unit admission. RESULTS: Among 759 patients included, 105 had hypomagnesemia (magnesium level < 1.6 mg/dL), 558 had normal serum magnesium levels (1.6-2.4 mg/dL), and 96 had hypermagnesemia (magnesium level > 2.4 mg/dL) at intensive care unit admission. From intensive care unit admission to day 5, the hypomagnesemia group had higher serum lactate levels and a higher frequency of lactic acidosis than the normal magnesium level and hypermagnesemia groups (70% vs. 51.6% vs. 50%; P < 0.001). Hypomagnesemia at intensive care unit admission was independently associated with lactic acidosis, i.e., lactic acid level > 2 mmol/L (odds ratio, 2.76; 95% confidence interval, 1.60-4.76; P < 0.001). CONCLUSIONS: Hypomagnesemia was associated with serum lactate levels in the early and post-resuscitation phases of sepsis. Further studies are needed to elucidate whether the magnesium status is associated with sepsis-induced cellular and metabolic abnormalities.
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Respiratory care 69(4) 525-526 2024年3月27日
MISC
7-
Clinical Engineering 35(4) 2024年
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日本集中治療医学会雑誌 30(Suppl.1) S352-S352 2023年6月
書籍等出版物
31-
(株)メディカル・サイエンス・インターナショナル 2024年3月<文献概要>非同調とは,「人工呼吸器」と「患者自身の自発呼吸」のタイミングがズレている現象である。人工呼吸器は,患者の自発呼吸と同調すべく,さまざまな方法で自発呼吸の開始や終了をモニタリングしているが,それでも非同調は実に多くの時間に出現している。見過ごすことのないよう,「非同調」についての正しい知識を身につけることが重要である。非同調を理解するには,「換気のどのタイミングで,どのような非同調が発生するのか」を把握することが大切である。本稿では,非同調の種類を「吸気開始のタイミング(トリガー)」と「呼気開始のタイミング(サイクリング)」に分けることから始める(表1)。次に,それぞれの非同調の特徴や原因について解説する。そして,人工呼吸器の調整や患者に対する介入手段を述べる。
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(株)メディカ出版 2023年6月 (ISBN: 9784840480628)▼VCVは、一回換気量を一定とする換気モードです。▼換気量を保つことができますが、気道内圧の上昇に注意し管理する必要があります。▼グラフィックを観察して、気道抵抗やプラトー圧を評価できるようにしましょう。(著者抄録)
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(株)メディカ出版 2023年6月 (ISBN: 9784840480628)▼圧規定換気(PCV)は、吸気圧と呼気圧を繰り返すことで換気を行います。▼吸気圧は、呼気圧との差を調節することで、目標の一回換気量となるように設定します。▼コンプライアンスが低いときや気道抵抗が高いときは、一回換気量を確保するために吸気圧を高くします。▼肺保護換気のためにプラトー圧や駆動圧を意識した設定が大切です。(著者抄録)
講演・口頭発表等
127共同研究・競争的資金等の研究課題
3-
日本学術振興会 科学研究費助成事業 2024年4月 - 2027年3月
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日本学術振興会 科学研究費助成事業 基盤研究(C) 2023年4月 - 2026年3月
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日本学術振興会 科学研究費助成事業 若手研究 2021年4月 - 2023年3月