The Japanese Society of Intensive Care Medicine最新文献

Focused cardiac ultrasound (FoCUS) and comprehensive echocardiography in the ICU 聚焦心脏超声(FoCUS)和综合超声心动图在ICU中的应用

The Japanese Society of Intensive Care Medicine Pub Date : 2021-09-01 DOI: 10.3918/JSICM.28_419

Y. Tokita, Takeshi Yamamoto

引用次数: 0

Pitfalls in the diagnosis of sepsis 败血症诊断的陷阱

The Japanese Society of Intensive Care Medicine Pub Date : 2021-09-01 DOI: 10.3918/JSICM.28_415

K. Atagi, S. Fukuda, Michitaka Nakamura

引用次数: 0

Delayed diagnosis of septic shock due to comorbid severe pulmonary hypertension: a case report 合并严重肺动脉高压导致脓毒性休克的延误诊断1例

The Japanese Society of Intensive Care Medicine Pub Date : 2021-09-01 DOI: 10.3918/JSICM.28_459

Yumi Yamamoto, M. Yamaoka, Eriko Minami, Ryoko Yamamoto, Naohisa Matsumoto, Daisuke Okabe, K. Nishimura, T. Kurasako

{"title":"Delayed diagnosis of septic shock due to comorbid severe pulmonary hypertension: a case report","authors":"Yumi Yamamoto, M. Yamaoka, Eriko Minami, Ryoko Yamamoto, Naohisa Matsumoto, Daisuke Okabe, K. Nishimura, T. Kurasako","doi":"10.3918/JSICM.28_459","DOIUrl":"https://doi.org/10.3918/JSICM.28_459","url":null,"abstract":"患者:71歳,女性,140 cm,47 kg 。既往歴:特発性間質性肺炎,気管支喘息があり,在宅酸素療法を導入中であった。モンテルカストナトリウム,テオフィリン,サルメテロールキシナホ酸塩, 塩酸プロカテロール,L-カルボシステインを内服中であったが,ステロイドなどの免疫抑制薬の内服はなかった。現病歴:定期受診2ヶ月前から安静時の呼吸困難が出現し,1ヶ月前には乾性咳嗽を認めていた。定期診察のために来院した呼吸器内科外来の待合室で突然の嘔吐後,意識レベルが低下し,橈骨動脈触知不能となった。初期対応時,JCSでIII-300の意識障害を認め,呼吸は浅く喘ぎ様であった。体温は36.9°C,心拍数は 82/minで,頸動脈の触知は可能であったが,非観血的血圧測定と橈骨動脈の触知は不可能であった。経胸壁心臓超音波検査では,右室の著明な拡大と,それに伴う左室の圧排を認め(Fig. 1a),三尖弁圧較差は66 mmHg(4ヶ月前,40 mmHg)と上昇していた。経過から肺血栓塞栓症を疑い,ICUへ入室した。 ICU入室後,直ちに気管挿管・人工呼吸を開始したが,P/F比は396で酸素化は維持されていた。観血的血圧測定による収縮期血圧は 40 mmHg未満であった。アドレナリンの静注を開始し,肺血栓塞栓症を念頭に未分画ヘパリンを5,000単位投与した後,造影CT を撮影した。造影CTでは明らかな塞栓子を認めず (Fig. 1b),肺野条件では両肺野のすりガラス陰影の増悪を認めた(Fig. 1c)。その後の肺動脈カテーテル検査にて,肺動脈圧は体血圧 110/65 mmHgに対し, 75/40 mmHgと上昇していた。血液検査では,シアル化糖鎖抗原KL-6 1,333 U/mL,脳性ナトリウム利尿ペプチド 869.9 pg/mLと上昇を認めた。また,白血球数 14.9×103/μL,乳酸値6.4 mmol/Lと上昇を認めたが,膀胱温36.9°C,CRP値0.16 mg/dLと正常であり, 臓器不全を示唆する所見も認めなかった。前述の所見から,肺血栓塞栓症を否定し,間質性肺炎の急性増悪とそれに伴う重症肺高血圧症と診断し,メチルプレドニゾロン1,000 mg/dayの投与を開始した。しかし,ICU入室8時間後に39.8°Cの発熱とプロカルシトニン値の上昇(2.63 ng/mL)を認めたため,血液培養・尿培養・喀痰培養を採取した後,ピペラシリン/タゾバクタムの投与を開始した。培養採取翌日に血液培養2/2セットから大腸菌が検出され,菌血症であったことが明らかとなった。来院時の造影CTでは明らかな腸管虚血・逆行性尿路感染・肝胆道系異常・膿瘍形成を示唆する所見は認めず,喀痰培養,尿培養は陰性であった。腹痛・関節痛などの局所異常所見も重症肺高血圧症の存在により診断が遅れた敗血症性ショックの 1例","PeriodicalId":22583,"journal":{"name":"The Japanese Society of Intensive Care Medicine","volume":"78 1","pages":"459-460"},"PeriodicalIF":0.0,"publicationDate":"2021-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"76839978","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

A case of a pediatric patient with ICU-acquired weakness and reduction in cross-sectional area of psoas muscle diagnosed using CT examination 小儿重症监护下获得性虚弱及腰大肌横截面积缩小的病例

The Japanese Society of Intensive Care Medicine Pub Date : 2021-09-01 DOI: 10.3918/JSICM.28_469

Shohei Hayakawa, Hideyuki Oritsu, M. Ohtsuka

{"title":"A case of a pediatric patient with ICU-acquired weakness and reduction in cross-sectional area of psoas muscle diagnosed using CT examination","authors":"Shohei Hayakawa, Hideyuki Oritsu, M. Ohtsuka","doi":"10.3918/JSICM.28_469","DOIUrl":"https://doi.org/10.3918/JSICM.28_469","url":null,"abstract":"患者は身長125 cm,体重40.3 kgの9歳の男児で,軽度の知的障害はあるが,意志の疎通は可能で日常生活も自立していた。神経筋疾患や呼吸循環器系の異常は認めなかった。今回,両側低形成腎・慢性腎不全に対して同種生体腎移植術を受けた(Day 0)が,腹壁が緊満して閉腹できず,開腹状態でICUに入室した。その後,静脈吻合部に血栓を生じて移植腎の機能は徐々に低下した。Day 14に移植腎を摘出して閉腹したが,感染による創離開で再度開腹状態となった(Day 18)。抗菌薬治療で感染炎症は改善し,Day 22に再閉腹術を施行した。 Day 0からDay 22までは,腹圧上昇抑制のため持続鎮静を行った。筋弛緩薬は投与せず,フェンタニル・ミダゾラム・デクスメデトミジンの持続静注でState Behavioral Scale1)-1〜-2程度の安静を維持できた。免疫抑制目的のメチルプレドニゾロン125 mg/dayを Day 0から投与し,漸減後Day 19まで投与した。超音波検査で循環血液量を頻回に評価し,晶質輸液負荷または利尿薬投与を適宜行った。経過中,心機能の低下は認めなかった。血清電解質は適宜測定して補正した。栄養は経腸栄養を主体とし,総熱量最大34 kcal/kg/day,タンパク質最大1.2 g/kg/dayを病期に応じて投与した。血糖値は,即効型インスリンの持続投与(2〜39単位/day)でおよそ100〜180 mg/dLに管理した。人工呼吸器の換気モードは主にプレッシャーサポート換気とし,サポート圧は適正換気を維持できる最低圧に調節した。Day 16のサポート圧は4 cmH2Oだったが, Day 23には12 cmH2Oを要し,人工呼吸器からの離脱は困難だった。P/F比は187〜490だったが,体形と安静に起因する無気肺によるものと考えられた。胸部単純X 線写真でも無気肺以外の異常所見を認めなかった。四肢の筋力は全般的に低下し,Day 19のMedical Research Council (MRC)scoreは60点満点中38点と低値だった。以上より,心肺機能異常や神経筋疾患,中枢神経障害を疑う所見がなく,人工呼吸器離脱困難であることと MRC scoreが低値であることからICU-AWと診断した。一方,原病の治療のために施行した腹部CT検査では,第 3腰椎レベルの左大腰筋の断面積が術前の5.0 cm2から Day 20には4.1 cm2に減少していた(Fig. 1)。なお,腸腰筋断面積はsliceOmatic 5.0 (Rev-2a, tomovision, Canada)で算出した。理学療法士はICU入室時から介入した。当初は移植腎 CT検査で大腰筋断面積の縮小を確認できた ICU-acquired weaknessを合併した小児患者の1例","PeriodicalId":22583,"journal":{"name":"The Japanese Society of Intensive Care Medicine","volume":"73 1","pages":"469-470"},"PeriodicalIF":0.0,"publicationDate":"2021-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"85812230","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

A case of electronic-cigarette or vaping product use-associated lung injury in a young man 一名年轻男子因使用电子烟或电子烟产品导致肺损伤的病例

The Japanese Society of Intensive Care Medicine Pub Date : 2021-09-01 DOI: 10.3918/JSICM.28_465

Junichi Fujioka, Shinya Fukuda, Takashi Miyauchi

引用次数: 0

Factors predicting the inability to self-manage medication after discharge from the intensive care unit: a retrospective cohort study 预测重症监护病房出院后无法自我管理药物的因素:一项回顾性队列研究

The Japanese Society of Intensive Care Medicine Pub Date : 2021-09-01 DOI: 10.3918/JSICM.28_437

S. Yoshihiro, T. Tomita, M. Sakuraya, Kazuto Onozuka, Yoshihiro Hashimoto

{"title":"Factors predicting the inability to self-manage medication after discharge from the intensive care unit: a retrospective cohort study","authors":"S. Yoshihiro, T. Tomita, M. Sakuraya, Kazuto Onozuka, Yoshihiro Hashimoto","doi":"10.3918/JSICM.28_437","DOIUrl":"https://doi.org/10.3918/JSICM.28_437","url":null,"abstract":"Objectives: This study aimed to identify factors associated with medication non-adherence at hospital discharge and calculate cut-off values for these factors. Methods: A logistic regression model was prepared using a retrospective dataset of 141 cases. Age, sex, the number of drugs prescribed after ICU discharge, the score on the motor and cognitive compo-nents of the functional independence measure (FIM), and the Charlson comorbidity index score were analyzed as potential independent risk factors for medication non-adherence after discharge. Cut-off values and diagnostic accuracy were evaluated by receiver operating characteristic curve, and the results were calibrated against another retrospective dataset of 72 cases, which was collected over a different period. Results: The age ≥ 75 years (OR 3.81, 95%CI 1.33–10.9) and scoring ≤ 4 on more than one item in the cognitive component of the FIM were found to be independent risk factors for medication non-adherence after ICU discharge. A FIM cognitive score cut-off of ≤ 26 had high diagnostic accuracy (sensitivity 62.5%, specificity 88.1%), and the accuracy ratio was highly consistent between the two datasets. Conclusions: The FIM cognitive score and age at ICU admission were independent risk factors for medication non-adherence after discharge, and the diagnostic accuracy was highest for a FIM cognitive score cut-off of 26 points or less.","PeriodicalId":22583,"journal":{"name":"The Japanese Society of Intensive Care Medicine","volume":"66 1","pages":"437-443"},"PeriodicalIF":0.0,"publicationDate":"2021-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"83375838","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

A case of malignant catatonia successfully diagnosed and treated with intravenous lorazepam 成功诊断恶性紧张症1例，静脉注射劳拉西泮治疗

The Japanese Society of Intensive Care Medicine Pub Date : 2021-09-01 DOI: 10.3918/JSICM.28_450

K. Nakashima, J. Maki, Keita Takahashi, Kazuhiro Shirozu, Yuji Shono, K. Tokuda, T. Akahoshi, K. Yamaura

{"title":"A case of malignant catatonia successfully diagnosed and treated with intravenous lorazepam","authors":"K. Nakashima, J. Maki, Keita Takahashi, Kazuhiro Shirozu, Yuji Shono, K. Tokuda, T. Akahoshi, K. Yamaura","doi":"10.3918/JSICM.28_450","DOIUrl":"https://doi.org/10.3918/JSICM.28_450","url":null,"abstract":"Malignant catatonia is a syndrome characterized by psychomotor disorder with autonomic symptoms and hyper-thermia. A 53-year-old woman with schizophrenia presented hyperthermia, immobility, mutism and rigidity, and was transported to our emergency room. After admission to the psychiatric ward, she developed respiratory failure. She was brought to the ICU and intensive care was initiated. After the exclusion of neuroleptic malignant syndrome and other physical diseases, we suspected malignant catatonia due to an exacerbation of schizophrenia. Thus, we administered lorazepam (1 mg, intravenously). Three minutes after the administration of lorazepam, her immobility, mutism and rigidity were ameliorated. When malignant catatonia is suspected, malignant catatonia should be differentially diagnosed from other physical diseases, while general care is provided to prevent complications. Then, a therapeutic diagnosis with lorazepam should be considered. Because lorazepam has a rapid onset, it is appropriate for the diagnosis and treatment of malignant catatonia.","PeriodicalId":22583,"journal":{"name":"The Japanese Society of Intensive Care Medicine","volume":"128 1","pages":"450-453"},"PeriodicalIF":0.0,"publicationDate":"2021-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"78418072","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

A case of delayed hemolytic transfusion reaction found to be the D-- phenotype during burn treatment 迟发性溶血性输血反应1例，发现在烧伤治疗期间为D-表型

The Japanese Society of Intensive Care Medicine Pub Date : 2021-09-01 DOI: 10.3918/JSICM.28_461

Takahiro Yamada, Y. Tsujimoto, N. Matsumura, Noriko Monma, H. Okuyama, Mika Kato, K. Morino

引用次数: 0

Trans-catheter treatment for severe functional mitral regurgitation after acute myocardial infarction 急性心肌梗死后重度功能性二尖瓣反流的经导管治疗

The Japanese Society of Intensive Care Medicine Pub Date : 2021-09-01 DOI: 10.3918/JSICM.28_417

S. Shirai

引用次数: 0

The future of treatment for respiratory infection with kampo medicine 汉布药治疗呼吸道感染的前景

The Japanese Society of Intensive Care Medicine Pub Date : 2021-09-01 DOI: 10.3918/JSICM.28_429

Rie Ono, S. Takayama, Ryutaro Arita

引用次数: 0