基本情報
研究分野
1経歴
7-
2020年10月 - 現在
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2020年4月 - 2021年9月
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2016年4月 - 2020年3月
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2014年4月 - 2016年3月
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2013年4月 - 2014年3月
学歴
3-
2015年4月 - 2019年3月
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2000年4月 - 2006年3月
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1997年4月 - 2000年3月
論文
100-
European journal of trauma and emergency surgery : official publication of the European Trauma Society 2024年5月23日PURPOSE: While follow-up CT and prophylactic embolization with angiography are often conducted during non-operative management (NOM) for BLSI, particularly in a high-grade injury, the utility of early repeated CT for preventing unexpected hemorrhage remains unclear. This study aimed to elucidate whether early follow-up computerized tomography (CT) within 7 days after admission would decrease unexpected hemostatic procedures on pediatric blunt liver and spleen injury (BLSI). METHODS: A post-hoc analysis of a multicenter observational cohort study on pediatric patients with BLSI (2008-2019) was conducted on those who underwent NOM, in whom the timing of follow-up CT were decided by treating physicians. The incidence of unexpected hemostatic procedure (laparotomy and/or emergency angiography for ruptured pseudoaneurysm) and complications related to BLSI were compared between patients with and without early follow-up CT within 7 days. Inverse probability weighting with propensity scores adjusted patient demographics, comorbidities, mechanism and severity of injury, initial resuscitation, and institutional characteristics. RESULTS: Among 1320 included patients, 552 underwent early follow-up CT. Approximately 25% of patients underwent angiography on the day of admission. The incidence of unexpected hemostasis was similar between patients with and without early repeat CT (8 [1.4%] vs. 6 [0.8%]; adjusted OR, 1.44 [0.62-3.34]; p = 0.40). Patients with repeat CT scans more frequently underwent multiple angiographies (OR, 2.79 [1.32-5.88]) and had more complications related to BLSI, particularly bile leak (OR, 1.73 [1.04-2.87]). CONCLUSION: Follow-up CT scans within 7 days was not associated with reduced unexpected hemostasis in NOM for pediatric BLSI.
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Academic emergency medicine : official journal of the Society for Academic Emergency Medicine 2024年4月8日OBJECTIVE: The objective was to investigate whether early advanced airway management during the entire resuscitation period is associated with favorable neurological outcomes and survival in patients with out-of-hospital cardiac arrest (OHCA). METHODS: We performed a retrospective cohort study of patients with OHCA aged ≥18 years enrolled in OHCA registry in Japan who received advanced airway management during cardiac arrest between June 2014 and December 2020. To address resuscitation time bias, we performed risk set matching analyses in which patients who did and did not receive advanced airway management were matched at the same time point (min) using the time-dependent propensity score; further, we compared early (≤10 min) and late (>10 min) advanced airway management. The primary and secondary outcome measures were favorable neurological outcomes using Cerebral Performance Category scores and survival at 1 month after cardiac arrest. RESULTS: Of the 41,101 eligible patients, 21,446 patients received early advanced airway management. Thus, risk set matching was performed with a total of 42,866 patients. In the main analysis, early advanced airway management was significantly associated with favorable neurological outcomes (risk ratio [RR] 0.997, 95% confidence interval [CI] 0.995-0.999) and survival (RR 0.990, 95% CI 0.986-0.994) at 1 month after cardiac arrest. In the sensitivity analysis with early advanced airway management defined as ≤5 min and ≤20 min, the results were comparable. CONCLUSIONS: Although early advanced airway management was statistically significant for improved neurological outcomes and survival at 1 month after cardiac arrest, the RR was very close to 1, indicating that the timing of advanced airway management has minimal impact on clinical outcomes, and decisions should be made based on the individual needs of the patient.
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Journal of pediatric surgery 2023年11月4日BACKGROUND: This study aimed to assess whether the grade of contrast extravasation (CE) on CT scans was associated with massive transfusion (MT) requirements in pediatric blunt liver and/or spleen injuries (BLSI). METHODS: This multicenter retrospective cohort study included pediatric patients (≤16 years old) who sustained BLSI between 2008 and 2019. MT was defined as transfusion of all blood products ≥40 mL/kg within the first 24 h of admission. Associations between CE and MT requirements were assessed using multivariate logistic regression analysis with cluster-adjusted robust standard errors to calculate the adjusted odds ratio (AOR). RESULTS: A total of 1407 children (median age: 9 years) from 83 institutions were included in the analysis. Overall, 199 patients (14 %) received MT. CT on admission revealed that 54 patients (3.8 %) had CE within the subcapsular hematoma, 100 patients (7.1 %) had intraparenchymal CE, and 86 patients (6.1 %) had CE into the peritoneal cavity among the overall cohort. Multivariate analysis, adjusted for age, sex, age-adjusted shock index, injury severity, and laboratory and imaging factors, showed that intraparenchymal CE and CE into the peritoneal cavity were significantly associated with the need for MT (AOR: 2.50; 95 % CI, 1.50-4.16 and AOR: 4.98; 95 % CI, 2.75-9.02, respectively both p < 0.001). The latter significant association persisted in the subgroup of patients with spleen and liver injuries. CONCLUSION: Active CE into the free peritoneal cavity on admission CT was independently associated with a greater probability of receiving MT in pediatric BLSI. The CE grade may help clinicians plan blood transfusion strategies. LEVEL OF EVIDENCE: Level 4; Therapeutic/Care management.
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Journal of critical care 77 154299-154299 2023年10月PURPOSE: We performed a network meta-analysis (NMA) of multiple tracheostomy timings using data from randomized control trials (RCTs) to investigate the impact on patient prognosis. MATERIALS AND METHODS: We searched MEDLINE, CENTRAL, ClinicalTrials.gov, and World Health Organization International Clinical Trials Platform Search Portal for RCTs on mechanically ventilated patients aged ≥18 years on February 2, 2023. We classified the timing of tracheostomy into three groups based on the clinical importance and previous studies: ≤ 4 days, 5-12 days, and ≥ 13 days. The primary outcome was short-term mortality, defined as mortality at any reported time point up to hospital discharge. RESULTS: Eight RCTs were included. The results revealed no effect between ≤4 days vs. 5-12 days and 5-12 days vs. ≥ 13 days and a significant effect in ≤4 days vs. ≥ 13 days as follows: in ≤4 days vs. 5-12 days (RR, 0.79 [95% CI, 0.56-1.11]; very low certainty), ≤ 4 days vs. ≥ 13 days (RR, 0.67 [95% CI, 0.49-0.92]; very low certainty), and 5-12 days vs. ≥ 13 days (RR, 0.85 [95% CI, 0.59-1.24]; very low certainty). CONCLUSIONS: Tracheostomy ≤4 days may result in lower short-term mortality than tracheostomy ≥13 days.
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Acta diabetologica 2023年9月20日INTRODUCTION: Diabetic ketoacidosis (DKA) and hyperglycemic hyperosmolar syndrome (HHS) are life-threatening complications of diabetes mellitus. Their clinical profiles have not been fully investigated. METHODS: A multicenter retrospective cohort study was conducted in 21 acute care hospitals in Japan. Patients included were adults aged 18 or older who had been hospitalized from January 1, 2012, to December 31, 2016 due to DKA or HHS. The data were extracted from patient medical records. A four-group comparison (mild DKA, moderate DKA, severe DKA, and HHS) was performed to evaluate outcomes. RESULTS: A total of 771 patients including 545 patients with DKA and 226 patients with HHS were identified during the study period. The major precipitating factors of disease episodes were poor medication compliance, infectious diseases, and excessive drinking of sugar-sweetened beverages. The median hospital stay was 16 days [IQR 10-26 days]. The intensive care unit (ICU) admission rate was 44.4% (mean) and the rate at each hospital ranged from 0 to 100%. The in-hospital mortality rate was 2.8% in patients with DKA and 7.1% in the HHS group. No significant difference in mortality was seen among the three DKA groups. CONCLUSIONS: The mortality rate of patients with DKA in Japan is similar to other studies, while that of HHS was lower. The ICU admission rate varied among institutions. There was no significant association between the severity of DKA and mortality in the study population. TRIAL REGISTRATION: This study is registered in the UMIN clinical Trial Registration System (UMIN000025393, Registered 23th December 2016).
MISC
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Pancreatology : official journal of the International Association of Pancreatology (IAP) ... [et al.] 20(3) 307-317 2020年3月6日BACKGROUND/OBJECTIVES: Severe acute pancreatitis (SAP) has a high mortality rate despite ongoing attempts to improve prognosis through a various therapeutic modalities. This study aimed to delineate etiology-based routes that may guide clinical decisions for the treatment of SAP. METHODS: Using data from a recent retrospective multicenter study in Japan, we analyzed the association between clinical outcomes, mainly in-hospital mortality and pancreatic infection, and various etiologies while considering confounding factors. We performed additional multivariate analyses and built decision tree models. RESULTS: The 1097 participating patients were classified into the following groups by etiology: alcohol (n = 436, 39.7%); cholelithiasis (n = 230, 21.0%); idiopathic (n = 227, 20.7%); and others (n = 204, 18.6%). Mortality at hospital discharge was 8.4%, 12.2%, 16.7%, and 16.2% in the alcohol, cholelithiasis, idiopathic, and others groups, respectively. According to multivariable analysis, early enteral nutrition (EN) was significantly associated with reduced in-hospital mortality only in the cholelithiasis group. However, there was a consistent association between age and the need for mechanical ventilation and increased mortality, regardless of etiology. Our decision tree models presented different contributing factors depending on the etiology and patient background. Interaction analysis showed that EN and the use of prophylactic antibiotics may influence these results differently according to etiology. CONCLUSIONS: No study has yet used comprehensive models to investigate etiology-related prognostic factors for SAP; our results can, therefore, be used as a reference for improving clinical decisions.
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Journal of gastrointestinal surgery : official journal of the Society for Surgery of the Alimentary Tract 24(9) 2037-2045 2019年8月19日BACKGROUND: Infected acute necrotic collections (ANC) and walled-off necrosis (WON) of the pancreas are associated with high mortality. The difference in mortality between open necrosectomy and minimally invasive therapies in these patients remains unclear. METHODS: This retrospective multicenter cohort study was conducted among 44 institutions in Japan from 2009 to 2013. Patients who had undergone invasive treatment for suspected infected ANC/WON were enrolled and classified into open necrosectomy and minimally invasive treatment (laparoscopic, percutaneous, and endoscopic) groups. The association of each treatment with mortality was evaluated and compared. RESULTS: Of 1159 patients with severe acute pancreatitis, 122 with suspected infected ANC or WON underwent the following treatments: open necrosectomy (33) and minimally invasive treatment (89), (laparoscopic three, percutaneous 49, endoscopic 37). Although the open necrosectomy group had a significantly higher mortality on univariate analysis (p = 0.047), multivariate analysis showed no significant associations between open necrosectomy or Charlson index and mortality (p = 0.29, p = 0.19, respectively). However, age (for each additional 10 years, p = 0.012, odds ratio [OR] 1.50, 95% confidence interval [CI] 1.09-2.06) and revised Atlanta criteria-severe (p = 0.001, OR 7.84, 95% CI 2.40-25.6) were significantly associated with mortality. CONCLUSIONS: In patients with acute pancreatitis and infected ANC/WON, age and revised Atlanta criteria-severe classification are significantly associated with mortality whereas open necrosectomy is not. The mortality risk for patients undergoing open necrosectomy and minimally invasive treatment does not differ significantly. Although minimally invasive surgery is generally preferred for patients with infected ANC/WON, open necrosectomy may be considered if clinically indicated.
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レジデントノート 20(11) 1957‐1965 2018年10月10日
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Medicina 55(10) 1662‐1667 2018年9月10日
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Medicina 55(10) 1652‐1657-1660 2018年9月10日<文献概要>Point ◎ストレス潰瘍予防薬は適応およびリスクと利益を吟味し,薬剤を使い分ける.◎深部静脈血栓症(DVT)予防は血栓と出血のリスクを併せて評価する.◎人工呼吸器関連肺炎(VAP)予防は5つのバンドルを遵守する.◎不必要な血管内カテーテルや尿道カテーテルは速やかに抜去する.
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Intensivist 10(3) 743-754 2018年7月<文献概要>Main points ●周術期酸素療法におけるアウトカムでは,術後呼吸器合併症(PPC)のみならず,死亡,手術部位感染(SSI),術後の悪心・嘔吐(PONV)も重要である。●周術期酸素療法を考慮する際には,術後のみならず術中の酸素投与も一連の流れとして考慮することが重要である。●現在までのエビデンスを統合すると,周術期における高濃度酸素投与によるPPC予防,死亡率低下,SSI予防,PONV予防への効果は定かではない。
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日本集中治療医学会雑誌 25(4) 271-277 2018年7月日本版敗血症診療ガイドライン(J-SSCG)2016作成特別委員会は、J-SSCG2016の普及状況をモニタリングすることと、今後のガイドライン改訂における改善点を明らかにすることを目的に、日本集中治療医学会、日本救急医学会の両学会員を対象とし、J-SSCG2016の使用に関する実態調査を実施した。610名から回答を得た。回答者の86%でJ-SSCG2016が活用されており、50〜75%程度の敗血症患者でガイドラインに準じた治療が行われていた。また、回答者の83%が診療の標準化、51%が教育の向上にJ-SSCG2016が役立つと評価した。一方、ガイドラインの存在意義、作成工程や発行・公開方法、両学会員以外の一般医療従事者における普及に関する問題を指摘する意見もあった。本調査結果を今後のJ-SSCG改訂に活かし、より実用的なガイドラインとして発展させていくことが重要と考えられる。(著者抄録)
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集中治療医学レビュー 2018-'19 103-109 2018年2月2011年に米国疾病予防センター(Centers for Disease Control and Prevention:CDC)の血管内留置カテーテル関連血流感染症(catheter-related blood stream infection:CRBSI)予防ガイドラインが改定されてから7年が経過した。CRBSIは重症患者管理における重大な医療デバイス関連感染症の一つであり、これまでは中心静脈カテーテル(central venous catheter:CVC)を対象とした研究報告が主流であったが、近年では動脈カテーテル(arterial catheter:AC)、末梢挿入型中心静脈カテーテル(peripherally inserted central catheter:PICC)、そして末梢静脈カテーテル(peripheral venous catheter:PVC)の報告が増加している。重症患者管理においてはCVCのみならずすべての血管内留置カテーテルの合併症に目を配らなければならない時代に突入した。しかし、まだまだ疫学情報が欠落しており、より大規模な研究が実施されることが望まれる。(著者抄録)
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Intensivist 10(1) 214-224 2018年1月
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呼吸器ケア (2017冬季増刊) 108-118 2017年12月
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Monthly Book Medical Rehabilitation (215) 72‐81-56 2017年10月15日
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MEDICAL REHABILITATION (215) 72-81 2017年10月人工呼吸療法は現在の医療において欠かすことができない治療法であるが、人工呼吸管理の長期化は多くの合併症を引き起こす弊害があり、臨床医は早期に人工呼吸器を離脱し、抜管することを常に念頭に置かなければならない。現在では人工呼吸器離脱のタイミングの評価は、医師の主観に頼らず、ある程度の基準に達すれば一気に抜管に向けてテストを試みる方法、すなわち自発呼吸テストを行うことが標準である。また、人工呼吸器離脱とは別に、抜管ができるかどうかの評価も同時並行で行う必要があり、そのためには排痰困難や呼吸筋疲労の評価や訓練、そして呼吸器リハビリテーション(以下、リハ)をより早期に導入し継続することが重要である。ABCDEFバンドルを活用し、明確な開始・中止基準を設け、多職種でリハにかかわることが重要であり、医師や看護師、リハ専門スタッフの綿密な連携の構築が必須である。(著者抄録)
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救急・集中治療 29(7-8) 458‐464-464 2017年7月20日
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救急・集中治療 29(7-8) 458-464 2017年7月<point>欧米においてMSSAの第一選択薬であるナフシリンやオキサシリンは我が国では保険収載がなく一般的には使用されていないことから、我が国での第一選択薬はセファゾリンとなっている。セファゾリン、アンピシリンおよびペニシリンの治療効果の優劣は定かではない。そのため感受性があり、より狭域に治療を行うのであればアンピシリンもしくはペニシリンの使用を考慮してもよい。(著者抄録)
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Intensivist 9(2) 421-437 2017年4月外傷・熱傷の初期輸液において,推奨される輸液製剤は乳酸リンゲル液などの晶質液であり,アルブミンに代表される膠質液は総輸液量を減少させる可能性はあるが予後には影響を与えない。外傷性出血性ショックにおけるpermissive hypotensionの有用性に関しては,まだまだ明確な結論は出ておらず,年齢や動脈硬化などの既往歴を参考にして個々の患者ごとに考慮する必要がある。外傷・熱傷の輸液管理は,熱傷における"fluid creep"に代表される大量輸液の弊害を避けるために「必要最低限な輸液量」を心掛けることが大切である。熱傷における初期輸液量は,大量輸液の弊害を避けるためにも,Parkland公式よりもその半分量である修正Brooke公式のほうがよい可能性がある。(著者抄録)
書籍等出版物
6講演・口頭発表等
39所属学協会
5-
2012年8月 - 現在
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 基盤研究(C) 2021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 基盤研究(C) 2019年4月 - 2024年3月
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日本学術振興会 科学研究費助成事業 2017年4月 - 2019年3月