Yoshikatsu Kawamura

Yamaguchi University, Yamaguti, Yamaguchi, Japan

Are you Yoshikatsu Kawamura?

Claim your profile

Publications (19)33.73 Total impact

  • [Show abstract] [Hide abstract]
    ABSTRACT: Study Objective Recent guidelines have emphasized the need for uninterrupted chest compressions. The purpose of this study was to evaluate the rescuer's tolerability of uninterrupted chest compressions. Methods Twenty-five healthy subjects performed uninterrupted chest compressions for 7 min at a rate of 100 compressions per min using a training manikin. The quality of chest compressions was assessed in terms of the total number and percentage of chest compressions, compression depth, recoil distance, and duty cycle. Correct chest compression was defined as a depth of 38-51 mm. Physiological and laboratory parameters were measured before and after the procedure. Fatigue was measured using a numerical rating scale (NRS). Data were compared before and after the procedure. Results The participants were 10 emergency physicians and 15 medical students. The compression rate was nearly 100 compressions per min. The number and percentage of correct compressions decreased gradually after 3 min. The compression depth decreased significantly after 2 min. The recoil distance and duty cycle were unchanged over 7 min. Systolic blood pressure, pulse rate, respiratory rate, NRS, serum lactate, adrenalin, and noradrenalin increased significantly after the procedure. Noradrenalin levels measured before the procedure were significantly and negatively correlated with the total number and percentage of correct compressions (r = − .587, P = .004; r = − .549, P = .008, respectively) Conclusions Performing uninterrupted chest compressions for 7 min is an arduous procedure. Higher noradrenalin levels before the procedure might be associated with incorrect chest compressions.
    The American Journal of Emergency Medicine. 01/2014;
  • [Show abstract] [Hide abstract]
    ABSTRACT: To investigate whether high mobility group box 1 (HMGB1) and S100B in cerebrospinal fluid (CSF) and the serum predict the neurological outcome in patients resuscitated from out-of-hospital cardiac arrest (OHCA). This study was designed as a prospective observational study. Twenty-five patients, who received standard cardiopulmonary resuscitation and post-resuscitation intensive care, were enrolled in this study. The patients were divided into two groups according to Glasgow-Pittsburgh Cerebral Performance categories (CPCs) at 6 months after return of spontaneous circulation (ROSC), Group G (n = 7, CPC 1 or 2) and Group P (n = 18, CPC ≥ 3). Their blood samples were taken at 6, 24, and 48h after ROSC. The patients, whose CSF was sampled at 48h, were also divided into either sub-Group G (n = 6) or sub-Group P (n = 8) at 6 months after ROSC. HMGB1 and S100B in CSF in sub-Group P were significantly higher than those in sub-Group G (HMGB1, <1.0 vs. 12.4 ng/ml, P = 0.009; S100B, 2.68 vs. 84.2 ng/ml, P = 0.007, respectively). HMGB1 in CSF was strongly correlated with S100B (σ = 0.81, P = 0.001). HMGB1 was elevated in serum at 6h and normalized within 48 h after ROSC without any significant differences between the two groups. Serum S100B in Group P was significantly higher than that in Group G at each time point. The significant elevations of HMGB1 and S100B in CSF, and S100B in serum are associated with the neurologically poor outcome in OHCA patients.
    Resuscitation 02/2012; 83(8):1006-12. · 4.10 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: The transpulmonary thermodilution technique allows the determination of cardiac preload (global end-diastolic volume index) and quantification of pulmonary edema (extravascular lung water index [EVLWI]). Pulmonary edema commonly develops in critically ill patients; however, the underlying pathophysiology, that is, hydrostatic (cardiac) or permeability-induced (noncardiac), often remains unclear. In this study, hemodynamic and serum parameters of osmolarity and oncotic pressure were analyzed to identify risk factors for increased EVLWI. A retrospective, single-center analysis in an intensive care unit of a university hospital was performed. No interventions were made for the study. Forty-two critically ill patients were included, and 126 simultaneous hemodynamic measurements and serum determinations were analyzed by logistic regression and Spearman rank correlation coefficient analysis. Global end-diastolic volume index (P = .001), serum albumin (P = .006), and serum osmolarity (P = .029) were significant factors for increased EVLWI (defined as >10 mL/kg). Hypervolemia, hypoalbuminemia, and high plasma osmolarity are associated with increased EVLWI.
    Journal of critical care 04/2011; 26(2):224.e9-13. · 2.13 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: Acute renal failure (ARF) is the most important complication of rhabdomyolysis. Serial measurements of blood myoglobin might be useful for predicting rhabdomyolysis-induced ARF. Thirty patients with rhabdomyolysis were examined. The causes of rhabdomyolysis were trauma, burns, and ischemia, among others. Serial blood myoglobin levels were measured by immunochromatography, and the peak value was determined. The relationship between blood myoglobin levels and the incidence of ARF was evaluated. The median peak blood myoglobin level was 3335 ng/mL. Acute renal failure occurred in 12 patients (40%). Nine patients (30%) underwent renal replacement therapy. Peak creatine kinase and peak blood myoglobin levels in the ARF group were significantly higher than those in the non-ARF group. Three patients in the ARF group were treated with renal replacement therapy before occurrence of uremia because of extremely high levels of blood myoglobin (>10,000 ng/mL). Receiver operating characteristic analysis showed that the area under the curve for blood myoglobin that predicted ARF was 0.88, and the best cutoff value for blood myoglobin was 3865 ng/mL. The peak value for blood myoglobin might be a good predictor of rhabdomyolysis-induced ARF. Early renal protective therapies should be considered for patients with rhabdomyolysis at high risk of ARF.
    Journal of critical care 12/2010; 25(4):601-4. · 2.13 Impact Factor
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: To investigate the prevalence and associated factors of delirium in critically ill patients during an intensive care unit (ICU) stay. We investigated 103 of 172 patients admitted consecutively to a university-based 20-bed ICU in a 3-month period. Six ICU physicians, who were familiar with the Confusion Assessment Method for the ICU (CAM-ICU), assessed patient delirium daily. Patient demographics, diagnosis, Acute Physiology and Chronic Health Evaluation (APACHE) II score, mechanical ventilation and maximum serum C-reactive protein (max-CRP) level during the ICU stay (max-CRP) were compared between patients who developed delirium and those who did not. Twenty-one (20%) of 103 patients and 13 (76%) of 17 mechanically ventilated patients developed delirium. APACHE II scores and max-CRP were significantly higher in patients who experienced delirium than in those who did not (P<.001). Use of a mechanical ventilator (P=.002), max-CRP (P=.032) and length of ICU stay (P=.043) were identified as independent associations for delirium development. The prevalence of delirium was 20% in ICU patients and 80% in ventilated patients in a Japanese ICU.
    General hospital psychiatry 01/2010; 32(6):607-11. · 2.67 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: Systemic capillary leak syndrome (SCLS) is a rare disease characterized by leakage of plasma from blood vessels into the interstitial space due to increased capillary permeability. We describe a 24-year-old man who was hospitalized with systemic edema, hypoalbuminemia, and disseminated intravascular coagulation. After extensive investigative procedures, he was diagnosed with chronic SCLS and made a gradual recovery after starting on prednisolone, terbutaline, and theophylline. We measured the patient's serum vascular endothelial growth factor (VEGF) over time and found a relationship between serum VEGF and the clinical course.
    Internal Medicine 01/2010; 49(8):791-4. · 0.97 Impact Factor
  • Nihon Kyukyu Igakukai Zasshi 01/2010; 21(5):245-251.
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: In postcardiac-arrest (PCA) patients, hyperglycemia is a factor reflecting an unfavorable outcome, and might be caused by the inflammation and stress of "sepsis-like" syndrome. In this study, plasma glucagon, a representative glycogenolytic and gluconeogenic hormone, was measured and assessed the correlation for neurological outcome in PCA patients. This study was a retrospective, single-medical-center analysis, conducted in the intensive care unit of a university hospital. Twenty-four sequential PCA patients were included. Plasma samples were collected from the patients on days 1, 2, and 3 after the return of spontaneous circulation (ROSC). Glucagon was compared in patients with favorable and unfavorable neurological outcomes. At all time points, plasma glucagon was significantly higher in patients with an unfavorable outcome (P<0.05). Glucagon on day 1 had remarkable sensitivity (88.2%) and specificity (85.8%) as an indicator of outcome, and correlated with the collapse-ROSC interval, the start of cardiopulmonary resuscitation (CPR)-ROSC interval, and the epinephrine dose during CPR. Plasma glucagon reflects unfavorable outcomes in PCA patients, and might be related to ischemic and reperfusion stress.
    Resuscitation 12/2009; 81(2):187-92. · 4.10 Impact Factor
  • Journal of the American Geriatrics Society 12/2009; 57(12):2368-9. · 3.98 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: The aim of this study is to determine effective biochemical markers and optimal sampling timing for prediction of neurological prognosis in post-surgical aneurysmal subarachnoid hemorrhage (SAH) patients. Subjects were a sequential group of SAH patients admitted to our centre who underwent aneurysm clipping before Day 3 and who received a cerebrospinal fluid (CSF) drain. CSF samples from 32 patients were collected on Days 3, 7, and 14. Neurological outcome was assessed by neurosurgeons using the Glasgow outcome scale (GOS) at 6 months after onset. CSF levels of neuron-specific enolase (NSE), S100B, and glial fibrillary acidic protein (GFAP) were determined using enzyme-linked immunosorbent assay, and the CSF concentrations of malondialdehyde (MDA) were determined using spectrophotometric assay. In univariate analysis, S100B on Days 3 and 14, GFAP on Days 3 and 7, and MDA on Day 14 were significantly higher in the poor outcome group (GOS 1-4) than in the good outcome group (GOS 5). In multivariate analysis, only MDA on Day 14 was identified as a significant predictor of poor neurological outcome at 6 months after onset. The area under the receiver-operating characteristic (ROC) curve for MDA on Day 14 was 0.841. For a threshold of 0.3 microM, sensitivity and specificity were 0.875 and 0.750, respectively. Our findings suggest that these biochemical markers, especially MDA, show significant promise as predictors of neurological outcome in clinical practice.
    Brain research bulletin 10/2009; 81(1):173-7. · 2.18 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: Heart rate variability (HRV) is widely used to evaluate autonomic nervous function; however, real-time monitoring of HRV has rarely been attempted in the intensive care unit (ICU). We report our experience in performing real-time monitoring of HRV in our ICU. We investigated 10 critically ill patients on total ventilatory support. Heart rate variability analysis was performed using the MemCalc system, which is a noninvasive, real-time analysis system. The low-frequency (LF) component of HRV reflects sympathetic and parasympathetic modulation, whereas the high-frequency (HF) component mainly reflects parasympathetic modulation. The LF/HF ratio represents a measure of sympathetic/parasympathetic balance. The HRV parameters for patients breathing spontaneously after extubation were significantly higher than those for patients on total ventilatory support. These findings suggest that mechanical ventilation under sedation may reduce autonomic nervous function in critically ill patients. In a representative case with septic shock, systolic blood pressure and LF/HF ratio showed a significant increase after intravenous infusion of epinephrine and then the HF component showed a significant increase due to vagal reflex. The MemCalc system is practicable for real-time monitoring of HRV in the ICU. Heart rate variability parameters may offer useful information in the management of critically ill patients.
    Journal of critical care 09/2009; 25(2):313-6. · 2.13 Impact Factor
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: We recently reported that excessive superoxide anion radical (O(2)(-)) was generated in the jugular vein during reperfusion in rats with forebrain ischemia/reperfusion using a novel electrochemical sensor and excessive O(2)(-) generation was associated with oxidative stress, early inflammation, and endothelial injury. However, the source of O(2)(-) was still unclear. Therefore, we used allopurinol, a potent inhibitor of xanthine oxidase (XO), to clarify the source of O(2)(-) generated in rats with forebrain ischemia/reperfusion. The increased O(2)(-) current and the quantified partial value of electricity (Q), which was calculated by the integration of the current, were significantly attenuated after reperfusion by pretreatment with allopurinol. Malondialdehyde (MDA) in the brain and plasma, high-mobility group box 1 (HMGB1) in plasma, and intercellular adhesion molecule-1 (ICAM-1) in the brain and plasma were significantly attenuated in rats pretreated with allopurinol with dose-dependency in comparison to those in control rats. There were significant correlations between total Q and MDA, HMGB, or ICAM-1 in the brain and plasma. Allopurinol pretreatment suppressed O(2)(-) generation in the brain-perfused blood in the jugular vein, and oxidative stress, early inflammation, and endothelial injury in the acute phase of forebrain ischemia/reperfusion. Thus, XO is one of the major sources of O(2)(-)- in blood after reperfusion in rats with forebrain ischemia/reperfusion.
    Brain research 09/2009; 1305:158-67. · 2.46 Impact Factor
  • Source
    Critical Care 01/2008; 12. · 4.93 Impact Factor
  • Critical Care Medicine - CRIT CARE MED. 01/2005; 33.
  • Nihon Kyukyu Igakukai Zasshi 01/2005; 16(3):126-130.
  • [Show abstract] [Hide abstract]
    ABSTRACT: We report a case of methanol intoxication, which was not distinguished from ethylene glycol intoxication during treatment. A 65-year-old man was transferred to our emergency department because of drowsiness and remarkable metabolic acidosis. He was intubated because his consciousness disturbance worsened. The diagnosis was suspected as methanol or ethylene glycol intoxication in addition to ethanol intoxication. Administration of ethanol and hemodialysis were chosen for his essential treatments. When he was extubated, he complained about visual loss. His brain computed tomography scans revealed putaminal lesions, which are rarely reported in methanol intoxication. Diagnosis of methanol intoxication was confirmed by the serum high methanol levels.
    Internal Medicine 09/2004; 43(8):750-4. · 0.97 Impact Factor
  • Nihon Kyukyu Igakukai Zasshi 01/2003; 14(11):719-722.
  • [Show abstract] [Hide abstract]
    ABSTRACT: This is a report of hemolytic anemia and respiratory failure due to Mycopkisma pneumoniae pneumonia. His chest CT scans showed bilateral diffuse thickened bronchovascular bundles and emphysematous changes. The pulmonary function test supported the diagnosis of chronic obstructive pulmonary disease (COPD). He was diagnosed as coldagglunitin-associated hemolytic anemia and M. pneumonzae pneumonia in inapparent COPD. Corticosteroid administration was remarkabily effective for hemolytic anemia and beneficial for acute exacerbation of COPD.
    Internal Medicine 04/2002; 41(3):229-32. · 0.97 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: Object: Because critically ill patients often have peripheral circulatory disturbance, it is very important to evaluate the status of peripheral circulation as well as cardiac function. We evaluted peripheral circulation in critically ill patients by pulsed Doppler ultrasonography. Methods: The subjects were 5 critically ill patients with the cold extremities. All of them were on mechanical ventilation in the intensive care unit. We measured the blood flow velocity of the radial artery before and during reactive hyperemia, which was induced by a 3-minute occlusion of the brachial artery by a tourniquest. Normal controls used for comparison were 10 healthy volunteers. Results: Skin temperature of the examined upper extremity in the patient group was significantly lower than that in the control group (26.1±2.4℃ versus 33.8±1.6℃,p<0.0001). Before reactive hyperemia, the mean blood flow velocity of the radial artery in the patient group was significantly lower than that in the control group (0.05±0.03 m/sec versus 0.27 ± 0.11 m/sec, p=0.0011). Pulsatility index and resistance index in the patient group were significantlly higher than those in the control group (9.3±4.4 versus 3.1±1.7, 1.4±0.3 versus 0.9±0.3, respectively). The baseline blood flow in all of the patient group had the reverse flow. The mean velocity of the reactive hyperemic blood flow in the patient group was significantly increased, compated witth that at baseline (0.05±0.03 m/sec to 0.21±0.11 m/sec, p<0.05), while pulsatility index and resistance index were significantly decreased. The increase rate of the mean flow velocity in reactive hyperemia was similar for both groups. Conclusion: The peripheral blood flow in criticallly ill patients with the cold extremities is significantly decreased, however the peripheral vascular responsiveness is maintained.