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Article: Guideline-based management of acute respiratory failure and acute respiratory distress syndrome.

Fujishima, Seitaro

2023 Volume 11, Issue 1, Page(s) 10

Abstract: Acute respiratory failure (ARF) is defined by acute and progressive hypoxemia caused by various cardiorespiratory or systemic diseases in previously healthy patients. Among ARF, acute respiratory distress syndrome (ARDS) is a serious condition with ... ...

Abstract	Acute respiratory failure (ARF) is defined by acute and progressive hypoxemia caused by various cardiorespiratory or systemic diseases in previously healthy patients. Among ARF, acute respiratory distress syndrome (ARDS) is a serious condition with bilateral lung infiltration, which develops secondary to a variety of underlying conditions, diseases, or injuries. This review summarizes the current standard of care for ARF and ARDS based on current major guidelines in this field. When administering fluid in patients with ARF, particularly ARDS, restrictive strategies need to be considered in patients without shock or multiple organ dysfunction. Regarding oxygenation targets, avoiding excessive hyperoxemia and hypoxemia is probably a reasonable choice. As a result of the rapid spread and accumulation of evidence for high-flow nasal cannula oxygenation, it is now weakly recommended for the respiratory management of ARF in general and even for initial management of ARDS. Noninvasive positive pressure ventilation is also weakly recommended for the management of certain ARF conditions and as initial management of ARDS. Low tidal volume ventilation is now weakly recommended for all patients with ARF and strongly recommended for patients with ARDS. Limiting plateau pressure and high-level PEEP are weakly recommended for moderate-to-severe ARDS. Prone position ventilation with prolonged hours is weakly to strongly recommended for moderate-to-severe ARDS. In patients with COVID-19, ventilatory management is essentially the same as for ARF and ARDS, but awake prone positioning may be considered. In addition to standard care, treatment optimization and individualization, as well as the introduction of exploratory treatment, should be considered as appropriate. As a single pathogen, such as SARS-CoV-2, exhibits a wide variety of pathologies and lung dysfunction, ventilatory management for ARF and ARDS may be better tailored according to the respiratory physiologic status of individual patients rather than the causal or underlying diseases and conditions.
Language	English
Publishing date	2023-03-10
Publishing country	England
Document type	Journal Article ; Review
ZDB-ID	2739853-5
ISSN	2052-0492
ISSN	2052-0492
DOI	10.1186/s40560-023-00658-3
Database	MEDical Literature Analysis and Retrieval System OnLINE

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Article ; Online: COVID-19: Stay Cool toward Corticosteroids.

Fujishima, Seitaro

The Keio journal of medicine

2020 Volume 69, Issue 2, Page(s) 27–29

MeSH term(s)	Adrenal Cortex Hormones/administration & dosage ; Adrenal Cortex Hormones/adverse effects ; Antiviral Agents/therapeutic use ; Betacoronavirus/drug effects ; Betacoronavirus/pathogenicity ; COVID-19 ; Clinical Trials as Topic ; Coronavirus Infections/diagnosis ; Coronavirus Infections/drug therapy ; Coronavirus Infections/epidemiology ; Coronavirus Infections/genetics ; Critical Illness ; Drug Administration Schedule ; Drug Dosage Calculations ; Humans ; Oseltamivir/therapeutic use ; Pandemics ; Pneumonia, Viral/diagnosis ; Pneumonia, Viral/drug therapy ; Pneumonia, Viral/epidemiology ; Pneumonia, Viral/genetics ; SARS-CoV-2
Chemical Substances	Adrenal Cortex Hormones ; Antiviral Agents ; Oseltamivir (20O93L6F9H)
Keywords	covid19
Language	English
Publishing date	2020-05-30
Publishing country	Japan
Document type	Journal Article
ZDB-ID	390981-5
ISSN	1880-1293 ; 0022-9717
ISSN (online)	1880-1293
ISSN	0022-9717
DOI	10.2302/kjm.2020-0007-LE
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Article: COVID-19: Stay Cool toward Corticosteroids

Fujishima, Seitaro

Keio J Med

Keywords	covid19
Publisher	WHO
Document type	Article
Note	WHO #Covidence: #689589
Database	COVID19

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Article ; Online: How do medical students learn in an online community diagnostics program?

Junji Haruta / Takayuki Ando / Seitaro Fujishima

BMC Medical Education, Vol 23, Iss 1, Pp 1-

2023 Volume 12

Abstract: Abstract Background The need to engage medical students in understanding the social and environmental determinants of health in disparate communities is increasing. However, previous reviews have noted the limited community diagnosis programs and program ...

Abstract	Abstract Background The need to engage medical students in understanding the social and environmental determinants of health in disparate communities is increasing. However, previous reviews have noted the limited community diagnosis programs and program evaluation. Given the feasibility of the programs, it is expected to be widely available online. Therefore, this study used a realist approach to identify learning patterns through an online community diagnosis program, namely context (C), mechanism (M), and outcomes (O) patterns. Methods A 2-week general medicine clinical practice program was conducted for 4th- and 5th-year medical students at a medical university in Japan. The program included a one-hour zoom-based lecture, feedback for students on their presentations on community diagnosis, and a structural report on community diagnosis. We developed the program based on variation theory, which views discernment and variation in situations having time, space, and social dimensions as core learning. The students' reflections on their learning through the program were thematically analyzed through CMO perspectives. The realist approach used in the online diagnosis program evaluation allows us to explore, test, and refine what mechanisms work under what conditions (context) and with what interventions (including opportunities and resources), from which we can describe iteratively explainable results. Results First, the medical students, who spent most of their time in the limited residential areas they lived in, discovered the characteristics of their own community by discovery learning and comparison among peers. Second, they increased their intrinsic interest in the community by discerning specific issues in their familiar community through community diagnosis. Third, they valued community diagnosis by identifying relationships between local data on health issues under their learning responsibility. Fourth, they become more flexible in their thinking and created new knowledge that would fit the local ...
Keywords	Realist approach ; Community diagnosis ; Learning mechanism ; Community-oriented ; Evaluation ; Learning outcomes ; Special aspects of education ; LC8-6691 ; Medicine ; R
Language	English
Publishing date	2023-01-01T00:00:00Z
Publisher	BMC
Document type	Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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Article: Organ dysfunction as a new standard for defining sepsis.

Fujishima, Seitaro

Inflammation and regeneration

2016 Volume 36, Page(s) 24

Abstract: Despite advances in intensive care and the widespread use of standardized care included in the Surviving Sepsis Campaign Guidelines, sepsis remains a leading cause of death, and the prevalence of sepsis increases concurrent with the aging process. The ... ...

Abstract	Despite advances in intensive care and the widespread use of standardized care included in the Surviving Sepsis Campaign Guidelines, sepsis remains a leading cause of death, and the prevalence of sepsis increases concurrent with the aging process. The diagnosis of sepsis was originally based on the evidence of persistent bacteremia (septicemia) but was modified in 1992 to incorporate systemic inflammatory response syndrome (SIRS). Since then, SIRS has become the gold standard for the diagnosis of sepsis. In 2016, the Society of Critical Care Medicine and the European Society of Intensive Care Medicine published a new clinical definition of sepsis that is called Sepsis-3. In contrast to previous definitions, Sepsis-3 is based on organ dysfunctions and uses a sequential organ failure (SOFA) score as an index. Thus, patients diagnosed with respect to Sepsis-3 will inevitably represent a different population than those previously diagnosed. We assume that this drastic change in clinical definition will affect not only clinical practice but also the viewpoint and focus of basic research. This review intends to summarize the pathophysiology of sepsis and organ dysfunction and discusses potential directions for future research.
Language	English
Publishing date	2016-11-15
Publishing country	England
Document type	Journal Article ; Review
ZDB-ID	2051471-2
ISSN	1880-9693 ; 0389-4290
ISSN	1880-9693 ; 0389-4290
DOI	10.1186/s41232-016-0029-y
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Article ; Online: Nasal intubation for trauma patients and increased in-hospital mortality.

Yamamoto, Ryo / Fujishima, Seitaro / Sasaki, Junichi

European journal of trauma and emergency surgery : official publication of the European Trauma Society

2022 Volume 48, Issue 4, Page(s) 2795–2802

Abstract: Purpose: Data regarding harm from nasal intubation in trauma patients have been conflicting. This study aims to elucidate whether nasal intubation is associated with increased in-hospital mortality compared with oral intubation.: Methods: A ... ...

Abstract	Purpose: Data regarding harm from nasal intubation in trauma patients have been conflicting. This study aims to elucidate whether nasal intubation is associated with increased in-hospital mortality compared with oral intubation. Methods: A retrospective cohort study on a nationwide trauma registry of 2004-2019 was conducted. Adult trauma patients who underwent nasal or oral intubation during initial resuscitation were selected. In-hospital mortality and lung complications were compared between nasal and oral intubations. A generalized estimating equation model accounting for within-institution clustering was adopted. Patient demographics, comorbidities, mechanism, injury severity, and vital signs on hospital arrival were adjusted. Subgroup analyses were conducted based on age, Abbreviated Injury Scale [AIS] for the head and face, and vital signs on arrival. Results: Among 29,271 patients eligible for the study, 667 were intubated nasally. In-hospital mortality was higher in nasal intubation compared with oral intubation (OR, 1.28 [95% CI, 1.01-1.64]). There were more noninfectious pulmonary complications in nasal intubation (OR, 1.48 [1.14-1.94]). The harms of nasal intubation were observed only in the elderly (age ≥ 75), patients with severe head injury (AIS in the head ≥ 4), and normotensive patients (systolic blood pressure ≥ 90 mmHg). Conversely, mortality was comparable regardless of the route of intubation in patients with complicated facial injury (AIS in the face ≥ 3). Conclusion: Nasal intubation was associated with increased in-hospital mortality, particularly in older patients and severe head injury, but not severe facial injury. The route of intubation should be judiciously decided during trauma resuscitation.
MeSH term(s)	Adult ; Aged ; Craniocerebral Trauma ; Facial Injuries ; Hospital Mortality ; Humans ; Injury Severity Score ; Intubation, Intratracheal ; Retrospective Studies
Language	English
Publishing date	2022-01-22
Publishing country	Germany
Document type	Journal Article
ZDB-ID	2275480-5
ISSN	1863-9941 ; 1863-9933
ISSN (online)	1863-9941
ISSN	1863-9933
DOI	10.1007/s00068-022-01880-8
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Article ; Online: Early versus delayed vasopressor administration in patients with septic shock.

Abe, Toshikazu / Umemura, Yutaka / Ogura, Hiroshi / Kushimoto, Shigeki / Fujishima, Seitaro / Saitoh, Daizoh / Gando, Satoshi

Acute medicine & surgery

2023 Volume 10, Issue 1, Page(s) e852

Abstract: Aim: This study aimed to investigate the association of early vasopressor initiation with improved septic shock outcomes.: Methods: This multicenter observational study was conducted in 17 intensive care units in Japan and included adult patients ... ...

Abstract	Aim: This study aimed to investigate the association of early vasopressor initiation with improved septic shock outcomes. Methods: This multicenter observational study was conducted in 17 intensive care units in Japan and included adult patients with sepsis admitted to the intensive care unit from July 2019 to August 2020 and treated with vasopressor therapy. Patients were divided into the early vasopressor group (≤1 h from sepsis recognition) and the delayed vasopressor group (>1 h). The impact of early vasopressor administration on risk-adjusted in-hospital mortality was estimated using logistic regression analyses adjusted by an inverse probability of treatment weighting analysis with propensity scoring. Results: Among the 97 patients, 67 received vasopressor therapy within 1 h from sepsis recognition and 30 received vasopressor after 1 h. In-hospital mortality was 32.8% in the early vasopressor group and 26.7% in the delayed vasopressor group ( Conclusion: Our study did not reach a definitive conclusion for early vasopressor administration. However, early vasopressor administration may help avoid volume overload in the long course of sepsis care.
Language	English
Publishing date	2023-05-27
Publishing country	United States
Document type	Journal Article
ZDB-ID	2751184-4
ISSN	2052-8817 ; 2052-8817
ISSN (online)	2052-8817
ISSN	2052-8817
DOI	10.1002/ams2.852
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Article: Pathophysiology and biomarkers of acute respiratory distress syndrome.

Fujishima, Seitaro

Journal of intensive care

2014 Volume 2, Issue 1, Page(s) 32

Abstract: Acute respiratory distress syndrome (ARDS) is defined as an acute-onset, progressive, hypoxic condition with radiographic bilateral lung infiltration, which develops after several diseases or injuries, and is not derived from hydrostatic pulmonary edema. ...

Abstract	Acute respiratory distress syndrome (ARDS) is defined as an acute-onset, progressive, hypoxic condition with radiographic bilateral lung infiltration, which develops after several diseases or injuries, and is not derived from hydrostatic pulmonary edema. One specific pathological finding of ARDS is diffuse alveolar damage. In 2012, in an effort to increase diagnostic specificity, a revised definition of ARDS was published in JAMA. However, no new parameters or biomarkers were adopted by the revised definition. Discriminating between ARDS and other similar diseases is critically important; however, only a few biomarkers are currently available for diagnostic purposes. Furthermore, predicting the severity, response to therapy, or outcome of the illness is also important for developing treatment strategies for each patient. However, the PaO2/FIO2 ratio is currently the sole clinical parameter used for this purpose. In parallel with progress in understanding the pathophysiology of ARDS, various humoral factors induced by inflammation and molecules derived from activated cells or injured tissues have been shown as potential biomarkers that may be applied in clinical practice. In this review, the current understanding of the basic pathophysiology of ARDS and associated candidate biomarkers will be discussed.
Keywords	covid19
Language	English
Publishing date	2014-05-07
Publishing country	England
Document type	Journal Article ; Review
ZDB-ID	2739853-5
ISSN	2052-0492
ISSN	2052-0492
DOI	10.1186/2052-0492-2-32
Database	MEDical Literature Analysis and Retrieval System OnLINE

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Article ; Online: Hyperoxia for sepsis and development of acute lung injury with increased mortality

Kazuma Yamakawa / Toshikazu Abe / Hiroshi Ogura / Seitaro Fujishima / Ryo Yamamoto / Junichi Sasaki / Satoshi Gando

BMJ Open Respiratory Research, Vol 10, Iss

2023 Volume 1

Abstract: Background Supraphysiological oxygen administration causes unfavourable clinical outcomes in various diseases. This study aimed to determine whether hyperoxia would be associated with increased mortality in patients with severe infection.Methods A post- ... ...

Abstract	Background Supraphysiological oxygen administration causes unfavourable clinical outcomes in various diseases. This study aimed to determine whether hyperoxia would be associated with increased mortality in patients with severe infection.Methods A post-hoc analysis of a nationwide multicentre prospective observational study on sepsis (SPICE Study) was conducted, including adult patients admitted to the intensive care unit with available arterial partial pressure of oxygen (PaO2) at the treatment initiation for severe infection. Hyperoxia was defined as a PaO2 level of ≥300 mm Hg and in-hospital mortality was compared between patients with and without hyperoxia.Results Of the 563 patients eligible for the study, 49 had hyperoxia at treatment initiation for severe infection. The in-hospital all-cause mortality rates of patients with and without hyperoxia were 14 (29.2%) and 90 (17.6%), respectively. Inverse probability weighting analyses with propensity scores revealed the association between hyperoxia and increased in-hospital mortality rate (28.8% vs 18.8%; adjusted OR 1.75 (1.03 to 2.97); p=0.038), adjusting for patient demographics, comorbidities, site of infection, severity of infection, haemodynamic and respiratory status, laboratory data and location of patient at infection development. Acute lung injury developed more frequently in patients with hyperoxia on the following days after infection treatment, whereas sepsis-related mortality was comparable regardless of hyperoxia exposure.Conclusion Hyperoxia with PaO2 ≥300 mm Hg at treatment initiation of severe infection was associated with an increased in-hospital mortality rate in patients requiring intensive care. The amount of oxygen to administer to patients with severe infection should be carefully determined.Trial registration number University Hospital Medical Information Network Clinical Trial Registry (UMIN000027452).
Keywords	Medicine ; R ; Diseases of the respiratory system ; RC705-779
Subject code	610
Language	English
Publishing date	2023-11-01T00:00:00Z
Publisher	BMJ Publishing Group
Document type	Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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Article ; Online: An algorithm for PCT-guided antimicrobial therapy: a consensus statement by Japanese experts.

Ito, Akihiro / Shime, Nobuaki / Fujishima, Seitaro / Fujitani, Shigeki / Komiya, Kosaku / Schuetz, Philipp

Clinical chemistry and laboratory medicine

2022 Volume 61, Issue 3, Page(s) 407–411

Abstract: In Japan, a national antimicrobial resistance (AMR) action plan was adopted in 2016, advocating a 20% reduction in antibiotic consumption by 2020. However, there is still room for improvement to accomplish this goal. Many randomized controlled trials ... ...

Abstract	In Japan, a national antimicrobial resistance (AMR) action plan was adopted in 2016, advocating a 20% reduction in antibiotic consumption by 2020. However, there is still room for improvement to accomplish this goal. Many randomized controlled trials have reported that procalcitonin (PCT)-guided antimicrobial therapy could help to reduce antibiotic consumption without negative health effects, specifically in acute respiratory infections. In September 2018, some experts in Europe and the USA proposed algorithms for PCT-guided antimicrobial therapy in mild to moderate infection cases outside the ICU and severe cases in the ICU (the international experts consensus). Thereafter, a group of Japanese experts, including specialists in intensive care medicine, emergency medicine, respiratory medicine and infectious diseases, created a modified version of a PCT-guided algorithm (Japanese experts consensus). This modified algorithm was adapted to better fit Japanese medical circumstances, since PCT-guided therapy is not widely used in daily clinical practice in Japan. The Japanese algorithm has three specific characteristics. First, the target patients are limited to only hospitalized ICU or non-ICU patients. Second, pneumonia due to
MeSH term(s)	Humans ; Algorithms ; Anti-Bacterial Agents/therapeutic use ; Biomarkers ; East Asian People ; Procalcitonin ; Antimicrobial Stewardship
Chemical Substances	Anti-Bacterial Agents ; Biomarkers ; Procalcitonin
Language	English
Publishing date	2022-12-02
Publishing country	Germany
Document type	Journal Article
ZDB-ID	1418007-8
ISSN	1437-4331 ; 1434-6621 ; 1437-8523
ISSN (online)	1437-4331
ISSN	1434-6621 ; 1437-8523
DOI	10.1515/cclm-2022-1048
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