Publications by authors named "Tomoko Fujii"

Article Synopsis
  • Clinical guidelines recommend using buffered crystalloid solutions for critically ill patients, but do not specify which type, prompting a survey of physicians' preferences between acetate- and lactate-buffered solutions.* -
  • An international survey of 1321 anesthesiologists and ICU physicians found that the majority used these solutions frequently, with varying availability of both types across different countries.* -
  • Most physicians supported a randomized trial comparing the two solutions, rating its clinical importance as significant, but not urgent, with a median score of 5 out of 9.*
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Purpose: Clinical trials focusing on critically ill patients with metabolic acidosis, a common exclusion criterion is the presence of a PaCO > 45 mmHg. The aim of this study was to assess the impact of mild hypercapnia on patient characteristics, severity, and clinical outcomes in critically ill patients with metabolic acidosis.

Material And Methods: Multicentre, retrospective, observational study conducted in 12 intensive care units (ICUs) in Queensland, Australia.

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Background And Objectives: Estimating heterogeneous treatment effects (HTEs) in randomized controlled trials (RCTs) has received substantial attention recently. This has led to the development of several statistical and machine learning (ML) algorithms to assess HTEs through identifying individualized treatment effects. However, a comprehensive review of these algorithms is lacking.

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Article Synopsis
  • - The **Mega-ROX HIE trial** is an international study designed to compare conservative versus liberal oxygen therapy in adults with hypoxic ischaemic encephalopathy (HIE) after cardiac arrest who are on mechanical ventilation in ICU settings.
  • - The **trial aims to enroll around 4,000 participants** and will measure all-cause mortality within 90 days from randomization as its primary outcome, alongside several secondary outcomes related to survival and hospital stay.
  • - The study is structured to reduce any potential analysis bias by clearly outlining its **protocol and statistical analysis plan**, and aims to provide insights into effective oxygen therapies for this population.
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Introduction: The Kidney Disease Improving Global Outcomes (KDIGO) clinical practice guideline recommends administering an effluent volume of 20-25 mL/kg/h during continuous renal replacement therapy (CRRT) for acute kidney injury. Recent evidence on CRRT initiation showed that less intervention might be beneficial for renal recovery. This study aimed to explore the association between early-phase low CRRT intensity and acid-base balance corrections and clinical outcomes.

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Critical care uses syndromic definitions to describe patient groups for clinical practice and research. There is growing recognition that a "precision medicine" approach is required and that integrated biologic and physiologic data identify reproducible subpopulations that may respond differently to treatment. This article reviews the current state of the field and considers how to successfully transition to a precision medicine approach.

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Background And Aims: The timing of transition from non-invasive ventilation (NIV) to invasive ventilation in the intensive care unit (ICU) is uncertain due to a lack of clinical evidence. This study aimed to identify the optimal timing of intubation in patients with respiratory failure managed with NIVs.

Methods: A single-center observational study was conducted in Tokyo, Japan.

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To assess the incidence and impact of metabolic acidosis in Indigenous and non-Indigenous patients Retrospective study. Adult intensive care units (ICUs) from Australia and New Zealand. Patients aged 16 years or older admitted to an Australian or New Zealand ICU in one of 195 contributing ICUs between January 2019 and December 2020 who had metabolic acidosis, defined as pH < 7.

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Article Synopsis
  • * Our analysis included over 1 million patients from 2008 to 2018, revealing that severe MA is much rarer (39.5 per million) compared to moderate MA (349.2-411.5 per million).
  • * Hospital mortality rates were significantly different: 48.3% for severe MA and 21.5% for moderate MA, highlighting the high risk of death associated with early severe MA despite its lower incidence.
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The effect of conservative versus liberal oxygen therapy on 90-day in-hospital mortality in patients who require unplanned invasive mechanical ventilation in an intensive care unit (ICU) is uncertain and will be evaluated in the mega randomised registry trial research program (Mega-ROX). To summarise the protocol and statistical analysis plan for Mega-ROX. Mega-ROX is a 40 000-patient parallel-group, registry-embedded clinical trial in which adults who require unplanned invasive mechanical ventilation in an ICU will be randomly assigned to conservative or liberal oxygen therapy.

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Background: The effect of conservative vs. liberal oxygen therapy on 90-day in-hospital mortality in adults who have nonhypoxic ischaemic encephalopathy acute brain injuries and conditions and are receiving invasive mechanical ventilation in the intensive care unit (ICU) is uncertain.

Objective: The objective of this study was to summarise the protocol and statistical analysis plan for the Mega-ROX Brains trial.

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Background: The effect of conservative vs. liberal oxygen therapy on 90-day in-hospital mortality in adults with sepsis receiving unplanned invasive mechanical ventilation in the intensive care unit (ICU) is uncertain.

Objective: The objective of this study was to summarise the protocol and statistical analysis plan for the Mega-ROX Sepsis trial.

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Background: This Rapid Practice Guideline provides an evidence-based recommendation to address the question: in adults with sepsis or septic shock, should we recommend using or not using intravenous vitamin C therapy?

Methods: The panel included 21 experts from 16 countries and used a strict policy for potential financial and intellectual conflicts of interest. Methodological support was provided by the Guidelines in Intensive Care, Development, and Evaluation (GUIDE) group. Based on an updated systematic review, and the grading of recommendations, assessment, development, and evaluation approach, we evaluated the certainty of evidence and developed recommendations using the evidence-to-decision framework.

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Unlabelled: In an analysis of claims data from a city in Japan, male patients and patients with dementia were less likely to receive osteoporosis pharmacotherapy after hip fracture. Treatment initiation rate has improved between 2014 and 2017.

Purpose: Older adults with recent hip fractures are at a high risk of recurrent fractures.

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Objectives: To identify the best population, design of the intervention, and to assess between-group biochemical separation, in preparation for a future phase III trial.

Design: Investigator-initiated, parallel-group, pilot randomized double-blind trial.

Setting: Eight ICUs in Australia, New Zealand, and Japan, with participants recruited from April 2021 to August 2022.

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Background: The complement pathway is a potential target for the treatment of severe COVID-19. We evaluated the safety and efficacy of ravulizumab, a terminal complement C5 inhibitor, in patients hospitalised with severe COVID-19 requiring invasive or non-invasive mechanical ventilation.

Methods: This phase 3, multicentre, open-label, randomised controlled trial (ALXN1210-COV-305) enrolled adult patients (aged ≥18 years) from 31 hospitals in France, Japan, Spain, the UK, and the USA.

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This article is one of ten reviews selected from the Annual Update in Intensive Care and Emergency Medicine 2023. Other selected articles can be found online at  https://www.biomedcentral.

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Article Synopsis
  • Thrombosis is a common complication associated with COVID-19, and this study aimed to examine geographical differences in thromboembolic events and prophylaxis in hospitalized patients.
  • A scoping review was conducted, analyzing data from 283 eligible studies worldwide, revealing that deep venous thrombosis (DVT) was most prevalent in Asia, while pulmonary embolism (PE) rates were highest in the Middle East and Europe.
  • The findings noted that low-molecular-weight heparin was commonly used for prophylactic anticoagulation across all regions, and while the incidences varied geographically, there were no significant differences in the types or doses of anticoagulants used.
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Background: Unfractionated heparin sodium and nafamostat mesylate have long been used as anticoagulants in continuous kidney replacement therapy (CKRT) where citrate is unavailable. This study aimed to determine whether heparin or nafamostat mesylate used during CKRT was associated with a longer filter life.

Methods: In this single-centre observational study, we included adult patients who required CKRT and used heparin or nafamostat mesylate for their first CKRT in the intensive care unit from September 1, 2013, to December 31, 2020.

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The Sequential Organ Failure Assessment (SOFA) score was developed more than 25 years ago to provide a simple method of assessing and monitoring organ dysfunction in critically ill patients. Changes in clinical practice over the last few decades, with new interventions and a greater focus on non-invasive monitoring systems, mean it is time to update the SOFA score. As a first step in this process, we propose some possible new variables that could be included in a SOFA 2.

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