Yoshikatsu Kawamura

Yamaguchi University, Yamaguti, Yamaguchi, Japan

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Publications (29)64.33 Total impact

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    ABSTRACT: Purpose: The purpose of the study was to determine whether pleural effusion (PE) is associated with a failure of high-flow nasal cannula (HFNC) therapy. Materials and methods: We conducted a single-center retrospective study. Seventy-three patients with acute respiratory failure given HFNC therapy between January 2012 and December 2014 were reviewed. HFNC failure was defined as intubation or noninvasive positive pressure ventilation following HFNC therapy. The numbers of quadrants with consolidation or ground glass opacity were counted on chest radiographs performed within 24 hours before starting HFNC therapy, and the PE score was calculated. PE score was the original score, verified by the computed tomographic images of some of the study patients. Results: Overall, 29 of 73 experienced HFNC failure. PE score was significantly greater in the HFNC failure group, but the number of quadrants with opacity was not significantly different. Age and Sequential Organ Failure Assessment (SOFA) score were significantly greater in the HFNC failure group. The PE (odds ratio, 1.49; 95% confidence interval, 1.10-2.02; P = .01) and SOFA (odds ratio, 1.33; 95% confidence interval, 1.05-1.68; P = .02) scores were independently associated with HFNC failure in multivariate analysis. Conclusions: The extent of PE on chest radiograph and SOFA score were associated with HFNC failure.
    No preview · Article · Dec 2015 · Journal of critical care
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    ABSTRACT: To determine the effects of cardiopulmonary resuscitation (CPR) with AutoPulse™ (LDB-CPR) on post-resuscitation injuries identified by post-mortem computed tomography (PMCT). AutoPulse™ is a novel mechanical chest-compression device with a load-distributing band (LDB) that may affect post-resuscitation injury identified by PMCT. We conducted a retrospective cohort study of non-traumatic adult out-of-hospital cardiac arrest patients whose death was confirmed in our emergency department between October 2009 and September 2014. Patients were divided according to whether LDB-CPR (LDB-CPR group) or manual CPR only (manual CPR only group) was performed. The background characteristics and post-resuscitation injuries identified by PMCT were compared between both groups. Logistic regression was used to identify risk factors for posterior rib fracture and abdominal injury. Overall, 323 patients were evaluated, with 241 (74.6%) in the LDB-CPR group. The total duration of CPR was significantly longer in the LDB-CPR group than in the manual CPR only group. Posterior rib fracture, hemoperitoneum, and retroperitoneal hemorrhage were significantly more frequent in the LDB-CPR group. The frequencies of anterior/lateral rib and sternum fracture were similar in both groups. Pneumothorax tended to be more frequent in the LDB-CPR group, although not significantly. LDB-CPR was an independent risk factor for posterior rib fracture (odds ratio 30.57, 95% confidence interval 4.15-225.49, P=0.001) and abdominal injury (odds ratio 4.93, 95% confidence interval 1.88-12.95, P=0.001). LDB-CPR was associated with higher frequencies of posterior rib fracture and abdominal injury identified by PMCT. PMCT findings should be carefully examined after LDB-CPR. (250 words). Copyright © 2015. Published by Elsevier Ireland Ltd.
    No preview · Article · Aug 2015 · Resuscitation
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    ABSTRACT: AimEarly prediction of the neurological outcomes of patients with out-of-hospital cardiac arrest is important to select the optimal clinical management. We hypothesized that clinical data recorded at the site of cardiopulmonary resuscitation would be clinically useful.Methods This retrospective cohort study included patients with return of spontaneous circulation after cardiopulmonary resuscitation who were admitted to our university hospital between January 2000 and November 2013 or two affiliated hospitals between January 2006 and November 2013. Clinical parameters recorded on arrival included age (A), arterial blood pH (B), time from cardiopulmonary resuscitation to return of spontaneous circulation (C), pupil diameter (D), and initial rhythm (E). Glasgow Outcome Scale was recorded at 6 months and a favorable neurological outcome was defined as a score of 4–5 on the Glasgow Outcome Scale. Multiple logistic regression analysis was carried out to derive a formula to predict neurological outcomes based on basic clinical parameters.ResultsThe regression equation was derived using a teaching dataset (total, n = 477; favourable outcome, n = 55): EP = 1/(1 + e−x), where EP is the estimated probability of having a favorable outcome, and x = (−0.023 × A) + (3.296 × B) − (0.070 × C) − (1.006 × D) + (2.426 × E) − 19.489. The sensitivity, specificity, and accuracy were 80%, 92%, and 90%, respectively, for the validation dataset (total, n = 201; favourable outcome, n = 25).Conclusion The 6-month neurological outcomes can be predicted in patients resuscitated from out-of-hospital cardiac arrest using clinical parameters that can be easily recorded at the site of cardiopulmonary resuscitation.
    No preview · Article · Jan 2015
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    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.
    No preview · Article · Aug 2014 · American Journal of Emergency Medicine
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    ABSTRACT: Extravascular lung water (EVLW), as measured by the thermodilution method, reflects the extent of pulmonary edema. Currently, there are no clinically effective treatments for preventing increases in pulmonary vascular permeability, a hallmark of lung pathophysiology, in patients with acute lung injury/acute respiratory distress syndrome (ALI/ARDS). In this study, we examined the contributions of hemodynamic and osmolarity factors, for which appropriate interventions are expected in critical care, to EVLW in patients with ALI/ARDS. We performed a subgroup analysis of a multicenter observational study of patients with acute pulmonary edema. Overall, 207 patients with ALI/ARDS were enrolled in the study. Multivariate regression analysis was used to evaluate the associations of hemodynamic and serum osmolarity parameters with the EVLW index (EVLWI; calculated as EVLW/Ideal body weight). We analyzed factors measured on the day of enrollment (day 0), and on days 1 and 2 after enrollment. Multivariate regression analysis showed that global end-diastolic volume index (GEDVI) was significantly associated with EVLWI measured on days 0, 1, and 2 (P = 0.002, P < 0.001, and P = 0.003, respectively), whereas other factors were not significantly associated with EVLWI measured on all 3 days. Among several hemodynamic and serum osmolarity factors that could be targets for appropriate intervention, GEDVI appears to be a key contributor to EVLWI in patients with ALI/ARDS. University Hospital Medical Information Network (UMIN) Clinical Trials Registry UMIN000003627.
    Full-text · Article · Apr 2014

  • No preview · Conference Paper · Mar 2014
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    ABSTRACT: Introduction: Recently, ILCOR and AHA have been recommended to treat patients, who returned spontaneous circulation (ROSC) from cardiac arrest, by therapeutic hypothermia. Recently, we have tried to examine predictors, such as internal jugular venous blood oxygen saturation (SjvO2), glucagon, glucose, glial fibrillary acidic protein, procalcitonin, interleukin-8, interleutin-6, S100B and high morbidity group box 1 in serum and/or cerebrospinal fluid (CSF) within 48 hours after ROSC. But those values could not be got within a few hours except for SjvO2. Therefore, we need a predictor to detect the outcome as soon as possible for farther treatments. Methods: This retrospective cohort study included patients with ROSC after CPR who were admitted to our university hospital between January 2000 and May 2011 or an affiliated hospital between January 2006 and May 2011. Clinical parameters recorded on arrival included age (A), arterial blood pH (B), time from CPR to ROSC (C), pupil diameter (D), and initial rhythm (E). Glasgow outcome scale (GOS) was recorded at 6 months and the patients were divided according to favorable or unfavorable neurological outcomes based on GOS score. Multiple logistic regression analysis was performed to derive a formula to predict neurological outcomes based on basic clinical parameters. Results: The regression equation was derived using a teaching dataset consisting of 389 records: EP = 1/(1 + e-x), where EP is the estimated probability of having a favorable outcome, and x = (-0.034 x A) + (4.669 x B) - (0.105 x C) - (0.976 x D) + (2.603 x E) - 28.279. The sensitivity, specificity, and accuracy were 86%, 91% and 91%, respectively, for the validation dataset (n = 100). Conclusions: The 6 month neurological outcomes can be predicted in patients resuscitated from OHCA using clinical parameters that can be easily recorded at the site of CPR.
    No preview · Conference Paper · Dec 2013

  • No preview · Article · Jan 2013 · Yamaguchi Medical Journal
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    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.
    No preview · Article · Feb 2012 · Resuscitation

  • No preview · Article · Jan 2012 · Nihon Shuchu Chiryo Igakukai zasshi
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    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.
    No preview · Article · Apr 2011 · Journal of critical care
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    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.
    No preview · Article · Dec 2010 · Journal of critical care
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    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.
    Preview · Article · Nov 2010 · General hospital psychiatry
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    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.
    No preview · Article · Apr 2010 · Internal Medicine

  • No preview · Article · Jan 2010 · Nihon Kyukyu Igakukai Zasshi
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    ABSTRACT: Objective: Serum cystatin C has been reported as a specific predictor of renal function and renal outcome in cardiac disease patients. In this study, serum cystatin C was measured in non-cardiac critically ill patients. We found that serum cystatin C was a predictive marker of renal dysfunction (RD) in these patients. Methods: The study design was a retrospective, single-medical-center analysis conducted in the intensive care unit of a university hospital. Two hundred fifty-nine critically ill patients were included in this study. RD was defined as a two-fold increase in the serum creatinine level or a requirement for renal replacement therapy (RRT) on the last ICU day. Serum cystatin C, estimated glomerular filtration rate (eGFR), APACHE II score, sequential organ failure assessment (SOFA) score, and vital signs on admission were analyzed using a logistic regression model and receiver operating characteristic (ROC) analysis. Results: APACHE II score (p=0.007) and serum cystatin C (p=0.020) were signifi cant risk factors for RD. The ROC analysis showed that a serum level of cystatin C greater than 1.50 mg/L had specificity for RD above 90%. Conclusions: Serum cystatin C is a predictive marker of RD in non-cardiac critically ill patients.
    No preview · Article · Jan 2010 · Critical Care and Shock
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    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.
    Full-text · Article · Dec 2009 · Resuscitation

  • No preview · Article · Dec 2009 · Journal of the American Geriatrics Society
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    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.
    No preview · Article · Oct 2009 · Brain research bulletin
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    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.
    Full-text · Article · Sep 2009 · Brain research