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Journal of intensive care 13(1) 15-15 2025年3月14日The 2024 revised edition of the Japanese Clinical Practice Guidelines for Management of Sepsis and Septic Shock (J-SSCG 2024) is published by the Japanese Society of Intensive Care Medicine and the Japanese Association for Acute Medicine. This is the fourth revision since the first edition was published in 2012. The purpose of the guidelines is to assist healthcare providers in making appropriate decisions in the treatment of sepsis and septic shock, leading to improved patient outcomes. We aimed to create guidelines that are easy to understand and use for physicians who recognize sepsis and provide initial management, specialized physicians who take over the treatment, and multidisciplinary healthcare providers, including nurses, physical therapists, clinical engineers, and pharmacists. The J-SSCG 2024 covers the following nine areas: diagnosis of sepsis and source control, antimicrobial therapy, initial resuscitation, blood purification, disseminated intravascular coagulation, adjunctive therapy, post-intensive care syndrome, patient and family care, and pediatrics. In these areas, we extracted 78 important clinical issues. The GRADE (Grading of Recommendations Assessment, Development and Evaluation) method was adopted for making recommendations, and the modified Delphi method was used to determine recommendations by voting from all committee members. As a result, 42 GRADE-based recommendations, 7 good practice statements, and 22 information-to-background questions were created as responses to clinical questions. We also described 12 future research questions.
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JMIR medical informatics 13 e64682 2025年3月12日This study demonstrated that while GPT-4 Turbo had superior specificity when compared to GPT-3.5 Turbo (0.98 vs 0.51), as well as comparable sensitivity (0.85 vs 0.83), GPT-3.5 Turbo processed 100 studies faster (0.9 min vs 1.6 min) in citation screening for systematic reviews, suggesting that GPT-4 Turbo may be more suitable due to its higher specificity and highlighting the potential of large language models in optimizing literature selection.
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Journal of Intensive Care 13(1) 2025年2月20日Abstract Background Lipoproteins and their component apolipoproteins play an important role in sepsis. However, little is known with regard to the association and causal contribution of these proteins to mortality in patients of different ancestries following septic shock. The objective of this study was to determine whether lipoprotein and apolipoprotein levels, and related genetic variants, are associated with clinical outcomes in septic shock. Methods We investigated the association between lipoprotein and apolipoprotein levels at the point of admission to the intensive care unit and in-hospital mortality in 687 Japan patients diagnosed with septic shock. For each clinically significant candidate protein, we extracted haplotype tag single nucleotide polymorphisms (SNPs) of the corresponding gene and examined the association of the candidate gene variants with 28-day mortality and organ dysfunction. We tested for replication in a Caucasian septic shock cohort (Vasopressin and Septic Shock Trial, VASST, n = 474). To determine whether the candidate lipoprotein causally contributed to septic shock outcome, we used a Mendelian randomization analysis based on polygenic scores generated from a genome-wide association study (GWAS) in the Japan cohort. Results In the Japan cohort, low apolipoprotein A-II levels were associated with increased septic shock mortality (adjusted odds ratio, 1.05; 95%CI, 1.02–1.09; P < 0.001). For a haplotype tag SNP of the corresponding ApoA2 gene, rs6413453 GG carriers had significantly higher 28-day mortality (adjusted hazard ratio [aHR], 1.79; 95% confidence interval [CI], 1.06–3.04; P = 0.029) and significantly fewer days free of cardiovascular, respiratory, renal and neurologic dysfunction than AG/AA carriers. This result was replicated in the Caucasian septic shock cohort (28-day mortality: aHR, 1.65; 95% CI, 1.02–2.68; P = 0.041). Mendelian randomization using 9 SNPs from an apolipoprotein A-II GWAS suggested that genetically decreased levels of apolipoprotein A-II were a causal factor for increased mortality in septic shock (odds ratio for mortality due to a 1 mg/dL decrease in apolipoprotein A-II is 1.05 [95% CI; 1.01–1.03, P = 0.0022]). Conclusions In septic shock, apolipoprotein A-II levels and ApoA2 genetic variations are important factors associated with outcome.
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Biomedical Physics & Engineering Express 11(2) 025026-025026 2025年2月6日Abstract Traumatic injury remains a leading cause of death worldwide, with traumatic bleeding being one of its most critical and fatal consequences. The use of whole-body computed tomography (WBCT) in trauma management has rapidly expanded. However, interpreting WBCT images within the limited time available before treatment is particularly challenging for acute care physicians. Our group has previously developed an automated bleeding detection method in WBCT images. However, further reduction of false positives (FPs) is necessary for clinical application. To address this issue, we propose a novel automated detection for traumatic bleeding in CT images using deep learning and multi-organ segmentation; Methods: The proposed method integrates a three-dimensional U-Net# model for bleeding detection with an FP reduction approach based on multi-organ segmentation. The multi-organ segmentation method targets the bone, kidney, and vascular regions, where FPs are primarily found during the bleeding detection process. We evaluated the proposed method using a dataset of delayed-phase contrast-enhanced trauma CT images collected from four institutions; Results: Our method detected 70.0% of bleedings with 76.2 FPs/case. The processing time for our method was 6.3 ± 1.4 min. Compared with our previous ap-proach, the proposed method significantly reduced the number of FPs while maintaining detection sensitivity.
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Artificial organs 2025年1月17日BACKGROUND: The pathogenesis of sepsis is thought to be linked to a dysregulated immune response, particularly that involving neutrophils. We have developed a granulocyte adsorption column as a "decoy organ," which relocates the massive inflammation in organs in the body to a blood purification column. This study was conducted to assess the safety and experimental effectiveness of granulocyte monocyte adsorption apheresis-direct hemoperfusion (G1-DHP) in the treatment of patients with sepsis, using a prospective, multicenter design. METHODS: The study included patients diagnosed with sepsis and with an APACHE II score ranging from 17 to 34. A total of five G1-DHP were performed within 3 days of patient enrollment. The primary endpoint was the change in sequential organ failure assessment (SOFA) score from enrollment to 7 days, and the safety endpoints were adverse events and mortality at 28 days. RESULTS: G1-DHP was performed on 82 patients. The median (interquartile range) SOFA score decreased from 10 (8-11) to 4 (3-7) after 7 days (n = 70; p < 0.01). Granulocytes, mainly neutrophils, were adsorbed, and the neutrophil-to-lymphocyte ratio significantly improved (p < 0.01). Notable improvements were observed in the SOFA scores for circulation and renal function. The acute physiology and chronic health evaluation II score of the 77 patients evaluated for mortality was 27, and the 28-day mortality rate was 7.8%. CONCLUSIONS: This study confirmed that G1-DHP can be safely used as an adjunct to standard sepsis treatment regimens. Although further investigations are required, G1-DHP is a promising supplemental therapy for sepsis. TRIAL REGISTRATION: jRCT1080225183 (Japan Registry of Clinical Trials identifier).
MISC
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日本救急医学会雑誌 32(S1) S1-S411 2021年2月日本集中治療医学会と日本救急医学会は,合同の特別委員会を組織し,2016年に発表した日本版敗血症診療ガイドライン(J-SSCG)2016の改訂を行った。本ガイドライン(J-SSCG2020)の目的は,J-SSCG2016と同様に,敗血症・敗血症性ショックの診療において,医療従事者が患者の予後改善のために適切な判断を下す支援を行うことである。改訂に際し,一般臨床家だけでなく多職種医療者にも理解しやすく,かつ質の高いガイドラインとすることによって,広い普及を目指した。J-SSCG2016ではSSCG2016にない新しい領域[ICU-acquircd weakness(ICU-AW)とpost-intensive care syndrome(POCS),体温管理など]を取り上げたが,J-SSCG2020では新たに注目すべき4領域(Patient-and Family-Centered Care, sepsis treatment system,神経集中治療,ストレス潰瘍)を追加し,計22領域とした。重要な118の臨床課題(clinical question:CQ)をエビデンスの有無にかかわらず抽出した。これらのCQには,本邦で特に注目されているCQも含まれる。多領域にわたる大規模ガイドラインであることから,委員25名を中心に,多職種(看護師,理学療法士,臨床工学技士,薬剤師)および患者経験者も含めたワーキンググループメンバー,両学会の公募によるシステマティックレビューメンバーによる総勢226名の参加・協力を得た。また,中立的な立場で横断的に活躍するアカデミックガイドライン推進班をJ-SSCG2016に引き続き組織した。将来への橋渡しとなることを企図して,多くの若手医師をシステマティックレビューチーム・ワーキンググループに登用し,学会や施設の垣根を越えたネットワーク構築も進めた。作成工程においては,質の担保と作業過程の透明化を図るために様々な工夫を行い,パブリックコメント募集は計2回行った。推奨作成にはGRADE方式を取り入れ,修正Delphi法を用いて全委員の投票により推奨を決定した。結果,118CQに対する回答として,79個のGRADEによる推奨,5個のGPS(good practice statement),18個のエキスパートコンセンサス,27個のBQ(background question)の解説,および敗血症の定義と診断を示した。新たな試みとして,CQごとに診療フローなど時間軸に沿った視覚的情報を取り入れた。J-SSCG2020は,多職種が関わる国内外の敗血症診療の現場において,ベッドサイドで役立つガイドラインとして広く活用されることが期待される。なお,本ガイドラインは,日本集中治療医学会と日本救急医学会の両機関誌のガイドライン増刊号として同時掲載するものである。(著者抄録)
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Therapeutic drug monitoring 42(4) 588-594 2020年2月11日BACKGROUND: The aim of this study was to conduct a population pharmacokinetic (PK) analysis of meropenem and to explore the optimal dosing strategy for meropenem in critically ill patients with acute kidney injury (AKI) receiving treatment with continuous hemodiafiltration (CHDF). METHODS: Blood samples were obtained on Days 1, 2, and 5 after the start of meropenem administration, immediately before dosing, and at 1, 2, 6, and 8 h after dosing. Population PK model analysis was performed and concentration-time profiles were simulated by using Nonlinear Mixed Effects Model software. RESULTS: Twenty-one patients receiving CHDF in our intensive care unit were enrolled and 350 serum concentration-time data points were obtained. The PK of meropenem were best described using a two-compartment model. Typical total and inter-compartmental clearance values were 4.22 L/h and 7.84 L/h, respectively, whereas the central and peripheral compartment volumes of distribution were 14.82 L and 11.75 L, respectively. Estimated glomerular filtration rate (eGFR) was identified as a significant covariate of meropenem total clearance. In simulations of patients with renal failure receiving CHDF, the dose was affected by eGFR; a dose of 0.5 g every 8 h or 1 g every 12 h showed the probability of target attainment of achieving 100% time above the minimum inhibitory concentration (MIC) for bacteria with an MIC ≤ 2 mg/L. CONCLUSION: A population PK model was developed for meropenem in critically ill patients with AKI receiving CHDF. Our results indicated that a meropenem dosage of 0.5 g every 8 h or 1 g every 12 h was suitable in this population and for susceptible bacteria.
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生体医工学 57 S253_2-S253_2 2019年6月<p>現在，動脈血酸素飽和度の連続モニタリングにはパルスオキシメータが使用されている．しかし，この装置は拍動の検知が必要であり，拍動が微弱な低灌流状態の患者には適用困難である．そこで，拍動を要しない組織酸素飽和度StO2モニタリングシステムを構築することが本研究の目的である．提案システムでは，透過光強度の計測に適した部位として，骨が存在せず薄い膜状組織である指間膜を選択した．本システムでは，キャリブレーションの為に，カフにより腕を圧迫及び開放することで起こる血流量変化に伴う指間膜の吸光度の変化を取得する．さらに，指間膜を強く圧迫し血液を追い出した状態で，指間膜吸光度を取得する．これらのデータにより，個人間の指間膜の違いを補正した状態でStO2の推定を行う．本システムの評価として，健常者を対象としたArterial Occlusion Testを実施し，従来のINVOS5100Cと比較した．その結果，推定したStO2は両者の間で高い相関（0.81±0.19）を示した．また，被験者全体のStO2の平均と標準偏差は，指間膜が73±6.8 %，INVOSが74±7.6 %となり，指間膜の方が比較的ばらつきが小さいという結果になった．今後は精度とユーザビリティの向上を目指す．</p>
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日本集中治療医学会雑誌 26(Suppl.) [JPD1-4] 2019年2月
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日本集中治療医学会雑誌 26(Suppl.) [JPD1-5] 2019年2月
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日本集中治療医学会雑誌 26(Suppl.) [JPD2-3] 2019年2月
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日本アフェレシス学会雑誌 37(Suppl.) 69-69 2018年10月
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日本救急医学会雑誌 29(7) 175-182 2018年7月日本版敗血症診療ガイドライン(J-SSCG)2016作成特別委員会は、J-SSCG2016の普及状況をモニタリングすることと、今後のガイドライン改訂における改善点を明らかにすることを目的に、日本集中治療医学会、日本救急医学会の両学会員を対象とし、J-SSCG2016の使用に関する実態調査を実施した。610名から回答を得た。回答者の86%でJ-SSCG2016が活用されており、50〜75%程度の敗血症患者でガイドラインに準じた治療が行われていた。また、回答者の83%が診療の標準化、51%が教育の向上にJ-SSCG2016が役立つと評価した。一方、ガイドラインの存在意義、作成工程や発行・公開方法、両学会員以外の一般医療従事者における普及に関する問題を指摘する意見もあった。本調査結果を今後のJ-SSCG改訂に活かし、より実用的なガイドラインとして発展させていくことが重要と考えられる。(著者抄録)
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日本集中治療医学会雑誌 25(4) 271-277 2018年7月日本版敗血症診療ガイドライン(J-SSCG)2016作成特別委員会は、J-SSCG2016の普及状況をモニタリングすることと、今後のガイドライン改訂における改善点を明らかにすることを目的に、日本集中治療医学会、日本救急医学会の両学会員を対象とし、J-SSCG2016の使用に関する実態調査を実施した。610名から回答を得た。回答者の86%でJ-SSCG2016が活用されており、50〜75%程度の敗血症患者でガイドラインに準じた治療が行われていた。また、回答者の83%が診療の標準化、51%が教育の向上にJ-SSCG2016が役立つと評価した。一方、ガイドラインの存在意義、作成工程や発行・公開方法、両学会員以外の一般医療従事者における普及に関する問題を指摘する意見もあった。本調査結果を今後のJ-SSCG改訂に活かし、より実用的なガイドラインとして発展させていくことが重要と考えられる。(著者抄録)
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日本集中治療医学会雑誌 25(Suppl.) [PD3-6] 2018年2月
共同研究・競争的資金等の研究課題
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日本学術振興会 科学研究費助成事業 2024年4月 - 2028年3月
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日本学術振興会 科学研究費助成事業 2024年4月 - 2027年3月
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日本学術振興会 科学研究費助成事業 2024年4月 - 2027年3月
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