Publications by authors named "Mutsuo Onodera"

Background: Mucoactive agents are often prescribed for the management of airway secretions. However, it is unclear whether they improve respiratory outcomes in mechanically ventilated patients.

Methods: We examined the association between the early administration of mucoactive agents in ventilated patients and increased ventilator-free days (VFDs).

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The prevalence of burnout among critical care professionals during the coronavirus disease (COVID-19) pandemic varies in different countries. To investigate the prevalence of burnout and turnover intention in Japanese critical care professionals in March 2021. This cross-sectional study used a web-based survey of Japanese critical care professionals working in 15 intensive care units in 15 prefectures.

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Context: The Laboratory Risk Indicator for Necrotizing Fasciitis (LRINEC) score helps to diagnose necrotizing soft-tissue infection (NSTI). The LRINEC score has been reported to be associated with poor prognosis, although few studies have evaluated this association.

Aims: We aimed to describe the characteristics of NSTI and assess whether the LRINEC score was associated with mortality and amputation.

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Background: Body mass index (BMI) can be an important indicator for health outcomes among critically ill patients. However, the association between BMI and ventilator dependence at ICU discharge among these patients remains unknown. We aimed to evaluate the association between BMI at ICU admission and ventilator dependence at the time of ICU discharge.

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Neuromuscular blocking agents play a significant role in improving the success rate for urgent intubation, although there is limited evidence about the effect on subsequent outcomes, such as the incidence of tracheostomy. In this retrospective cohort study, we aimed to examine the association between avoidance of neuromuscular blocking agents for urgent tracheal intubation and incidence of tracheostomy among patients in the intensive care unit (ICU). The setting of this study was an eight-bed ICU at a tertiary-care hospital in Okayama, Japan.

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Background: During high-flow oxygen therapy, heated humidified gas is delivered at high flow. Although the warmth and humidity of this gas facilitates mucociliary function in the lower airway, warm and humid conditions also promote bacterial growth. Bacterial contamination of high-flow oxygen therapy circuits has not been well investigated.

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Background: Most heat-and-moisture exchangers (HMEs) for patients with tracheostomy and spontaneously breathing are small and have suction ports that allow some expiratory gas to escape, which loses water vapor held in the expired gas. Recently, a heated-and-humidified high-flow system for spontaneously breathing patients with tracheostomy was developed. Little is known, however, about the humidifying performance of HMEs or heated-and-humidified high-flow systems for spontaneous breathing patients with a tracheostomy.

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Background: We previously reported the effects of high-flow nasal cannula (HFNC) oxygen therapy on thoraco-abdominal synchrony. This study was designed to clarify the effect of HFNC on thoraco-abdominal synchrony in pediatric subjects after cardiac surgery and to investigate HFNC optimal flow in this population.

Methods: Thoraco-abdominal synchrony was evaluated with respiratory inductive plethysmography.

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Background And Purpose: The Japanese Clinical Practice Guidelines for Management of Sepsis and Septic Shock 2016 (J-SSCG 2016), a Japanese-specific set of clinical practice guidelines for sepsis and septic shock created jointly by the Japanese Society of Intensive Care Medicine and the Japanese Association for Acute Medicine, was first released in February 2017 in Japanese. An English-language version of these guidelines was created based on the contents of the original Japanese-language version.

Methods: Members of the Japanese Society of Intensive Care Medicine and the Japanese Association for Acute Medicine were selected and organized into 19 committee members and 52 working group members.

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Article Synopsis
  • The Japanese Clinical Practice Guidelines for Management of Sepsis and Septic Shock 2016 (J-SSCG 2016) were created to address specific needs in Japan and are a joint effort by two medical societies, reflecting localized clinical practices.
  • The guidelines were developed with input from various medical professionals, utilizing a structured method that included public commentary and a peer review system to ensure quality and transparency in the drafting process.
  • In total, 87 clinical questions were identified across 19 areas of focus, including new topics relevant to pediatric care, with important revisions made since the previous version in 2012.
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Background: High-flow nasal cannula therapy (HFNC) is widely used for patients with acute respiratory failure. HFNC has a number of physiological effects. Although F is considered to be constant, because HFNC is an open system, F varies according to inspiratory flow, tidal volume (V), and HFNC gas flow.

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Background: Delayed discharge from ICU to the general ward can exert an adverse effect. We researched whether patients are discharged smoothly from our ICU to the general ward.

Methods: We defined that patients were eligible for discharge if they are without administration of catecholamine, being assisted by mechanical ventilation and having blood purification therapy.

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Background: Magnetic resonance imaging (MRI) is indispensable for diagnosing brain and spinal cord abnormalities. Magnetic components cannot be used during MRI procedures; therefore, patient support equipment must use MRI-compatible materials. However, little is known of the performance of MRI-compatible ventilators.

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Background: Excessive supplemental oxygen causes injurious hyperoxemia. Before establishing the best P(aO2) targets for mechanically ventilated patients, it is important to understand the incidence of hyperoxemia and related factors. We investigated oxygenation in mechanically ventilated subjects in our ICU and evaluated factors related to hyperoxemia (P(aO2) > 120 mm Hg) at 48 h after initiation of mechanical ventilation.

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Introduction: Although continuous or frequent stimuli in tracheostomized patients may cause tracheal granulomas, little is known about management of patients with translaryngeal intubation.

Case Presentation: A 1-month-old Japanese boy, weighing 3.5kg, was admitted to our hospital owing to cardiac failure caused by an atrial septal defect and intractable arrhythmia.

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Introduction: Although extracorporeal membrane oxygenation has made sufficient progress to be considered for the management of life-threatening cardiac and respiratory failure, the risk of hemorrhagic complications may outweigh the benefits for patients with bleeding tendencies. We report, to the best of our knowledge, the first case of successful treatment by extracorporeal membrane oxygenation, without any hemorrhagic complications, of postpartum cardiorespiratory failure after massive uterine bleeding.

Case Presentation: A 25-year-old Japanese woman experienced massive atonic bleeding after delivering her second baby.

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Introduction: Delivering heated and humidified medical gas at 20-60 L/min, high-flow nasal cannula (HFNC) creates low levels of PEEP and ameliorates respiratory mechanics. It has become a common therapy for patients with respiratory failure. However, independent measurement of heat and humidity during HFNC and comparison of HFNC devices are lacking.

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Purpose: Post-pyloric feeding tube placement is often difficult, and special equipment or peristalsis agents are used to aid insertion. Although several reports have described blind techniques for post-pyloric feeding-tube placement, no general consensus about method preference has been achieved.

Materials And Methods: The technique is performed as follows: via the nostril, a stylet-tipped feeding tube is advanced about 70 cm; to confirm tip location to the right of the epigastric area, towards the right hypochondriac region, 5 mL shots of air are injected to enable touch detection of bubbling; finally, the tube is advanced to a length of 100 cm, during which the strength of bubbling seems to diminish under palpation.

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Background: Because noninvasive ventilation (NIV) delivers medical gas at high flow, inadequate humidification may cause oral dryness and patient discomfort. Heated humidification can be used during NIV, but little has been reported about the effects on the hygrometric conditions inside an oronasal mask and oral dryness during 24 hours on NIV.

Methods: We measured absolute humidity (AH) inside oronasal masks on subjects with acute respiratory failure during 24 hours on NIV.

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Background: High-flow nasal cannula (HFNC) creates positive oropharyngeal airway pressure and improves oxygenation. It remains unclear, however, whether HFNC improves thoraco-abdominal synchrony in patients with mild to moderate respiratory failure. Using respiratory inductive plethysmography, we investigated the effects of HFNC on thoraco-abdominal synchrony.

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Objective: The acute physiology, age and chronic health evaluation (APACHE) II score and other related scores have been used for evaluation of illness severity in the intensive care unit (ICU), but there is still a need for real-time and sensitive prognostic biomarkers. Recently, alarmins from damaged tissues have been reported as alarm-signaling molecules. Although ATP is a member of the alarmins and its depletion in tissues closely correlates with multiple-organ failure, blood ATP level has not been evaluated in critical illness.

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Background: Heat and moisture exchangers (HMEs) are commonly used for humidifying respiratory gases administered to mechanically ventilated patients. While they are also applied to tracheostomized patients with spontaneous breathing, their performance in this role has not yet been clarified. We carried out a bench study to investigate the effects of spontaneous breathing parameters and oxygen flow on the humidification performance of 11 HMEs.

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Background: Although heated humidifiers (HHs) are the most efficient humidifying device for mechanical ventilation, some HHs do not provide sufficient humidification when the inlet temperature to the water chamber is high. Because portable and home-care ventilators use turbines, blowers, pistons, or compressors to inhale in ambient air, they may have higher gas temperature than ventilators with piping systems. We carried out a bench study to investigate the temperature of gas delivered from portable and home-care ventilators, including the effects of distance from ventilator outlet, fraction of inspiratory oxygen (FIO2), and minute volume (MV).

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