Publications by authors named "Shigeki Kushimoto"
The Japanese Society on Thrombosis and Hemostasis (JSTH) published the first-ever disseminated intravascular coagulation (DIC) guidelines in 2009. Fifteen years later, the JSTH developed new guidelines covering DIC associated with various underlying conditions. These guidelines were developed in accordance with the GRADE system to determine the strength of the recommendations and certainty of the evidence.
View Article and Find Full Text PDFDisseminated intravascular coagulation (DIC) associated with hematologic malignancies, particularly acute promyelocytic leukemia (APL), is characterized by marked fibrinolytic activation, which leads to severe bleeding complications. Therefore, appropriate diagnosis and management of DIC are crucial for preventing bleeding-related mortality. However, to date, no clinical guidelines have specifically addressed hematologic malignancy-associated DIC.
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- A study in Japan examined trends in mortality and treatment options for disseminated intravascular coagulation (DIC) from 2010 to 2022, finding a significant decline in in-hospital mortality by 17%.
- Data from over 443,000 DIC patients indicated that older age and worse health conditions were common, with noticeable mortality reductions in those with sepsis, solid cancer, and leukemia.
- There was a shift in treatment preferences, with recombinant thrombomodulin use increasing, while the concurrent use of antithrombin and recombinant thrombomodulin declined.
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- A study aimed to evaluate the adherence to a balanced transfusion strategy in severely injured patients in Japan, which is believed to lower mortality rates during resuscitation.
- The researchers analyzed data from the RESTRIC trial, categorizing patients into two massive transfusion groups based on the volume of red blood cell (RBC) transfusions they received.
- Results showed that while the ratio of fresh frozen plasma (FFP) to RBC transfusions was consistently balanced, the platelet concentrate (PC) to RBC ratio was not fully balanced, especially in the early phases of treatment.
Background: There was no study to investigate the association between the national surge of Coronavirus disease 2019 (COVID-19) patients and the mortality of mechanically ventilated COVID-19 patients. The aim of this study was to assess the association between mortality in mechanically ventilated COVID-19 patients and two distinct national COVID-19 surge indices: (1) the daily number of newly confirmed COVID-19 cases, representing overall medical demands and (2) the total number of critically ill COVID-19 patients, reflecting critical care demands.
Methods: We analyzed the patient data registered in a national database of mechanically ventilated COVID-19 patients between February 6, 2020, and May 16, 2023, combined with the data officially published by the Japanese government.
Article Synopsis
- Sepsis is a severe condition resulting from an overly reactive response to infection, with high rates of incidence and death globally, yet specific treatments remain elusive due to its complexity.
- Various studies have attempted to categorize sepsis into subclasses based on different biological markers and clinical features, although no two subclasses have consistent traits that would make them clinically applicable.
- Research continues to identify subclasses that not only reflect the underlying biological mechanisms but can also be reliably reproduced across different patient groups to improve treatment outcomes.
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- A hybrid emergency department (ED) setup in Japan has been developed to enhance trauma treatment, but its effects on out-of-hospital cardiac arrest (OHCA) cases requiring extracorporeal cardiopulmonary resuscitation (ECPR) are still being investigated.
- This study aimed to analyze how hybrid EDs impact ECPR procedures and outcomes, specifically looking at the time it takes for ECPR to start after a patient arrives at the hospital.
- Results showed that implementing a hybrid ED significantly reduced the time from hospital arrival to ECPR initiation, though there were no notable differences in neurological outcomes or adverse events compared to conventional EDs.
Background: Complications during veno-venous extracorporeal membrane oxygenation (VV-ECMO) are associated with in-hospital mortality. Asian patients on extracorporeal membrane oxygenation (ECMO) have higher risks of bleeding and in-hospital mortality than Caucasian patients. This study aimed to characterize and identify bleeding complications and their associated factors related to in-hospital mortality in patients with severe coronavirus disease 2019 (COVID-19) requiring VV-ECMO in Japan.
View Article and Find Full Text PDFBackground Timely and effective fluid resuscitation is vital for stabilizing sepsis while avoiding volume overload. We aimed to assess how the administration of a 30 mL/kg bolus fluid affects patients with sepsis within three hours of clinical outcomes. Methods This multicenter observational study included adult patients diagnosed with sepsis in 17 intensive care units at tertiary hospitals in Japan between July 2019 and August 2020.
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- Early identification of individuals at risk for functional impairment after trauma is essential for timely interventions, and this study focused on creating predictive models using data collected within 2 days of hospital admission.
- The research analyzed data from 8,529 trauma patients treated in Japan, finding that 41% experienced functional impairment upon discharge, with age being the most significant predictor of such impairment.
- Four predictive models were developed and validated, all demonstrating moderate accuracy, with the extreme gradient boosting model performing the best, indicating a promising approach for improving patient outcomes post-trauma.
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- In a study of out-of-hospital cardiac arrest patients undergoing extracorporeal cardiopulmonary resuscitation (ECPR), researchers explored how low-flow time affects survival outcomes, focusing on those with accidental hypothermia (AH).
- Out of 1,252 enrolled patients, 8.4% had AH, and those patients showed a higher survival discharge rate (44.8%) compared to those without AH (25.4%).
- The findings suggest that low-flow time does not significantly impact survival in AH patients, unlike non-AH patients where longer low-flow times negatively affect survival rates.
Background: Patients who receive invasive mechanical ventilation (IMV) in the intensive care unit (ICU) have exhibited lower in-hospital mortality rates than those who are treated outside. However, the patient-, hospital-, and regional factors influencing the ICU admission of patients with IMV have not been quantitatively examined.
Methods: This retrospective cohort study used data from the nationwide Japanese inpatient administrative database and medical facility statistics.
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.
Background: Japanese Association for Acute Medicine (JAAM) disseminated intravascular coagulation (DIC) criteria were launched nearly 20 years ago. Following the revised conceptual definition of sepsis and subsequent omission of systemic inflammatory response syndrome (SIRS) score from the latest sepsis diagnostic criteria, we omitted the SIRS score and proposed a modified version of JAAM DIC criteria, the JAAM-2 DIC criteria.
Objectives: To validate and compare performance between new JAAM-2 DIC criteria and conventional JAAM DIC criteria for sepsis.
Article Synopsis
- Limited data exists on the safety and effectiveness of 4-factor prothrombin complex concentrate (4F-PCC) in patients facing major bleeding or needing urgent surgery, particularly in Japan.
- A post-marketing study was conducted involving 1,381 patients who received 4F-PCC for the first time, with a follow-up period of 4 weeks, finding a high percentage (92%) of patients were on vitamin K antagonists and a notable incidence of intracranial hemorrhage.
- Results showed that 85.8% of patients achieved hemostatic effectiveness, with a low incidence of adverse drug reactions (3.9%) and thromboembolic events (1.5%), indicating that
Background: Coronavirus disease 2019 (COVID-19) has exposed critical care supply shortages worldwide. This study aimed to investigate the association between regional critical care capacity and the incidence of invasive mechanical ventilation following novel COVID-19 during the pandemic in Japan, a country with a limited intensive care unit (ICU) bed capacity of a median of 5.1 ICU beds per 100,000 individuals.
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- The study examined how different red blood cell transfusion strategies (restrictive vs. liberal) affect outcomes in trauma patients with varying lactate levels after injury.
- In a post hoc analysis of the RESTRIC trial involving 396 participants, researchers found that mortality rates after 28 days were similar regardless of the transfusion strategy.
- In patients with low lactate levels, the restrictive strategy was associated with more days free from ICU and ventilators, suggesting potential benefits of this approach for specific groups, despite similar survival rates.
Article Synopsis
- Trauma-induced coagulopathy (TIC) is a serious medical condition resulting from traumatic injuries, leading to abnormal blood clotting and increased bleeding, but there's little clarity on the best treatments available.
- The objective of the study is to systematically review and analyze the effectiveness and safety of various treatments for TIC, focusing on interventions like coagulation factor concentrates and tranexamic acid.
- The research will include a thorough review of existing studies, assessing outcomes like in-hospital mortality, and using established tools to evaluate the quality and bias of the studies included.
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- A study investigated the relationship between coagulopathy and patient outcomes in sepsis-induced acute respiratory distress syndrome (ARDS), focusing on which coagulopathy parameters could predict mortality and guide anticoagulant use.
- The researchers identified specific coagulopathy markers—prothrombin time and platelet count—as significant predictors of in-hospital mortality, with patients with certain coagulopathy types showing worse oxygenation recovery.
- Findings indicated that anticoagulants positively affected mortality and oxygenation recovery for patients with specific coagulopathy, highlighting the need for tailored treatment approaches in ARDS patients.
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- - This study investigated the relationship between the severity of contrast extravasation (CE) seen on CT scans and the need for massive transfusions (MT) in children with blunt liver and/or spleen injuries, over a span from 2008 to 2019.
- - The research included 1,407 pediatric patients, revealing that 14% required MT, and specific types of CE, particularly intraparenchymal and into the peritoneal cavity, significantly correlated with increased transfusion needs.
- - The findings suggest that recognizing active CE during initial CT scans can guide healthcare providers in making informed decisions about transfusion strategies for young patients with these types of injuries.
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- * The analysis included 1,524 patients, finding that prolonged low-flow times (over 40 minutes) were linked to significantly lower chances of survival and better neurological function compared to shorter low-flow times (0-40 minutes).
- * The study concluded that minimizing low-flow time is crucial for improving hospital discharge rates and neurological health in OHCA patients receiving ECPR, highlighting the importance of quick intervention.
Article Synopsis
- A study investigated the practices and trends of massive transfusion for trauma in Japan using a national database that includes a majority of emergency hospitals from 2011 to 2020.
- It found that only 0.15% of trauma patients received massive transfusions, and the incidence of these transfusions decreased significantly during the study period.
- Additionally, higher ratios of fresh frozen plasma to red blood cells were linked to better survival rates, while lower ratios increased hospital mortality and adverse events.
Aim: Multisystem inflammatory syndrome in adults (MIS-A) is a hyperinflammatory multisystem condition associated with coronavirus disease (COVID-19). Critically ill COVID-19 patients may develop multiorgan damage and elevated inflammatory responses, thus making it difficult to differentiate between progression to organ damage due to COVID-19 itself or MIS-A. This study aimed to explore the characteristics and complications of MIS-A in critical COVID-19 patients.
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