JaLCDOI 10.18926/AMO/56645
FullText URL 73_2_101.pdf
Author Iida, Atsuyoshi| Naito, Hiromichi| Yorifuji, Takashi| Zamami, Yoshito| Yamada, Akane| Koga, Tadashi| Imai, Toru| Sendo, Toshiaki| Nakao, Atsunori| Ichiba, Shingo|
Abstract Sedatives are administered during extracorporeal membrane oxygenation (ECMO) therapy to ensure patient safety, reduce the metabolic rate and correct the oxygen supply-demand balance. However, the concentrations of sedatives can be decreased due to absorption into the circuit. This study examined factors affecting the absorption of a commonly used sedative, midazolam (MDZ). Using multiple ex vivo simulation models, three factors that may influence MDZ levels in the ECMO circuit were examined: polyvinyl chloride (PVC) tubing in the circuit, use of a membrane oxygenator in the circuit, and heparin coating of the circuit. We also assessed changes in drug concentration when MDZ was re-injected in a circuit. The MDZ level decreased to approximately 60% of the initial concentration in simulated circuits within the first 30 minutes. The strongest factor in this phenomenon was contact with the PVC tubing. Membrane oxygenator use tended to increase MDZ loss, whereas heparin circuit coating had no influence on MDZ absorption. Similar results were obtained when a second dose of MDZ was injected to the second-use circuits.
Keywords sedatives ECMO polyvinyl chloride pharmacokinetics pharmacodynamics
Amo Type Original Article
Published Date 2019-04
Publication Title Acta Medica Okayama
Volume volume73
Issue issue2
Publisher Okayama University Medical School
Start Page 101
End Page 107
ISSN 0386-300X
NCID AA00508441
Content Type Journal Article
language 英語
Copyright Holders CopyrightⒸ 2019 by Okayama University Medical School
File Version publisher
Refereed True
PubMed ID 31015744
FullText URL K0005299_other1.pdf
Author Itoh, Hideshi| Ichiba, Shingo| Ujike, Yoshihito| Kasahara, Shingo| Arai, Sadahiko| Sano, Shuji|
Keywords Extracorporeal membrane oxygenation congenital heart disease cardiac surgery pediatric hypoplastic left heart syndrome
Note 学位審査副論文
Published Date 2012-05
Publication Title Perfusion
Volume volume27
Issue issue3
Publisher SAGE
Start Page 225
End Page 229
ISSN 0267-6591
NCID AA10674287
Content Type Journal Article
language 英語
OAI-PMH Set 岡山大学
Copyright Holders https://creativecommons.org/licenses/by-nc-nd/4.0/deed.ja
File Version author
PubMed ID 22249964
DOI 10.1177/0267659111434857
Web of Sience KeyUT 000303316500011
Related Url https://doi.org/10.1177/0267659111434857 http://ousar.lib.okayama-u.ac.jp/54282
JaLCDOI 10.18926/AMO/53557
FullText URL 69_4_213.pdf
Author Yumoto, Tetsuya| Sato, Keiji| Ugawa, Toyomu| Ichiba, Shingo| Ujike, Yoshihito|
Abstract Hyponatremia, a common electrolyte disorder associated with traumatic brain injuries (TBIs), has high mortality and morbidity rates. The aim of this study was to identify the risk factors for hyponatremia associated with TBI. We retrospectively analyzed the cases of TBI patients who were admitted to the emergency intensive care unit at Okayama University Hospital between October 2011 and September 2014. A total of 82 TBI patients were enrolled. The incidences of hyponatremia (serum sodium level of<135mEq/L) and severe hyponatremia (serum sodium level of<130mEq/L) within the first 14 days after admission were 51オ (n=42) and 20オ (n=16), respectively. After admission, hyponatremia took a median period of 7 days to develop and lasted for a median of 3 days. Multivariate analysis demonstrated that higher fluid intake from days 1 to 3 and the presence of cranial fractures were risk factors for hyponatremia. The 58 patients with hyponatremia experienced fewer ventilator-free days, longer intensive care unit stays, and less favorable outcomes compared to the 24 patients without hyponatremia;however, these differences were not significant. Further studies are needed to determine the optimal management strategy for TBI-associated hyponatremia in the intensive care unit setting.
Keywords traumatic brain injury hyponatremia cranial fracture fluid intake
Amo Type Original Article
Published Date 2015-08
Publication Title Acta Medica Okayama
Volume volume69
Issue issue4
Publisher Okayama University Medical School
Start Page 213
End Page 218
ISSN 0386-300X
NCID AA00508441
Content Type Journal Article
language 英語
Copyright Holders CopyrightⒸ 2015 by Okayama University Medical School
File Version publisher
Refereed True
PubMed ID 26289912
Web of Sience KeyUT 000365519100004
JaLCDOI 10.18926/AMO/32838
FullText URL fulltext.pdf
Author Komori, Eisaku| Shoga, Kazuhiko| Aoe, Motoi| Sawada, Shigeki| Ichiba, Shingo| Shimizu, Nobuyoshi|
Abstract <p>To elucidate the mechanism of anti-inflammatory effect of partial liquid ventilation (PLV), cytokine concentration, surface CD11b, and macrophage expression were investigated in BALF. The 30-minutes group was treated with gas ventilation (GV) for 30 minutes after intratracheal LPS administration. The GV group was prepared in the same manner as the 30-minutes group, then the GV was continued for the following 2 hours. The PLV group was treated in the same manner as the 30-minutes group, and then received PLV with perflubron for the following 2 hours. Animals were euthanized to receive BAL. The PLV group showed a tendency to have a higher concentration than the GV group of TNF-alpha, MIP-2, and CINC-1 as measured by ELISA, although there were no significant differences. The ratio of expressions of CD11b and macrophages to total leukocytes were determined by flow-cytometry. There were no significant differences in the ratio of CD11b-positive expression to acquired cells (GV: 63.6 +/- 8.4%, PLV: 60.5+/-5.4%, P=0.73). However, the proportion of macrophages was significantly increased (GV: 5.6 +/-1.5, PLV: 14.0+/-1.3, P=0.006). These results suggest that the anti-inflammatory effect of PLV is not caused by the change in CD11b expression, and that PLV affects the proportion of macrophage among BALF cells.</p>
Keywords partial liquid ventilation anti-inflammatory effect BAl cytokine flow cytometry
Amo Type Article
Published Date 2003-06
Publication Title Acta Medica Okayama
Volume volume57
Issue issue3
Publisher Okayama University Medical School
Start Page 133
End Page 141
ISSN 0386-300X
NCID AA00508441
Content Type Journal Article
language 英語
File Version publisher
Refereed True
PubMed ID 12908011
Web of Sience KeyUT 000183816500005
JaLCDOI 10.18926/AMO/32673
FullText URL fulltext.pdf
Author Ichiba, Shingo| Okabe, Kazunori| Date, Hiroshi| Shimizu, Nobuyoshi| Teramoto, Shigeru|
Abstract <p>Extracorporeal Membrane Oxygenation (ECMO) has been adopted as a means of strong respiratory support. In lung transplantation, reimplantation response is still a serious problem. It causes severe respiratory failure which is refractory to mechanical ventilation in some cases. The purpose of this study was to evaluate the effects of veno-venous ECMO after lung transplantation using a canine autotransplantation model. The autotransplantation model was created by keeping the left lung in a warm ischemic state for 2 h. After reperfusion, the right pulmonary artery was ligated. The following two groups were studied: Group 1, Control group, (no ECMO group) (n = 6). After reperfusion, both lungs were ventilated without ECMO. Group 2, ECMO group (n = 7). After reperfusion, veno-venous ECMO support was introduced with reduction of mechanical ventilation. In the no ECMO group, four of the animals died within 210 min after reperfusion. In the ECMO group, two of the animals died of severe pulmonary edema. Data of blood gas analyses (PaO2, PaCO2, and SvO2) after reperfusion were significantly better in the ECMO group, whereas there were no significant differences in both shunt fraction and pulmonary vascular resistance index. In this model with severe pulmonary edema induced by warm ischemia, veno-venous ECMO contributed to the improvement of hypoxemia and hypercapnia, but did not improve pulmonary hemodynamics.</p>
Keywords extracorporeal membrance oxygenation(ECMO) warm ischemia reimplantation response lung transplantation pulmonary edema veno-venous ECMO
Amo Type Article
Published Date 1992-06
Publication Title Acta Medica Okayama
Volume volume46
Issue issue3
Publisher Okayama University Medical School
Start Page 213
End Page 221
ISSN 0386-300X
NCID AA00508441
Content Type Journal Article
language 英語
File Version publisher
Refereed True
PubMed ID 1502926
Web of Sience KeyUT A1992JB50400010
JaLCDOI 10.18926/AMO/31327
FullText URL fulltext.pdf
Author Sawada, Shigeki| Ichiba, Shingo| Itano, Hideki| Shoga, Kazuhiko| Shimizu, Nobuyoshi|
Abstract <p>To study the effect of partial liquid ventilation (PLV) with perfluorocarbon on acute respiratory failure, 3 groups of 17 rabbits were examined to compare. After acute respiratory failure was induced by lung lavage with sea water in 12 of the 17 rabbits, 7 of the 12 rabbits were treated with conventional mechanical ventilation (AC group) and 5 of the 12 rabbits were treated with PLV using perfluorocarbon (AP group). The remaining 5 normal rabbits without acute respiratory failure were treated with PLV with perfluorocarbon as a control group (PL group). In the PL group, PaO2, PaCO2, blood pH, pulmonary compliance or pathological findings were not so changed after PLV. In the AC and AP groups, PaCO2 significantly increased, and in contrast, PaO2 and pulmonary compliance significantly decreased after lung lavage. However, these findings improved to almost the same levels as those of a control group within 2 h after the PLV treatment in the AP group, but in the AC group, these gradually deteriorated over time. As for the pathological findings, pulmonary vascular congestion, alveolar hemorrhage and inflammatory infiltration were observed in the AC group. However, these findings were not observed in the specimens of the AP group. From these results, PLV with perfluorocarbon was shown to be useful to improve gas exchange and pulmonary functions without major side effects.</p>
Keywords liquid ventitation perfluorocarbon acute respiratory failure lung lavage sea water
Amo Type Article
Published Date 1998-06
Publication Title Acta Medica Okayama
Volume volume52
Issue issue3
Publisher Okayama University Medical School
Start Page 131
End Page 137
ISSN 0386-300X
NCID AA00508441
Content Type Journal Article
language 英語
File Version publisher
Refereed True
PubMed ID 9661739
Web of Sience KeyUT 000074528500002
JaLCDOI 10.18926/AMO/30963
FullText URL fulltext.pdf
Author Terado, Michihisa| Ichiba, Shingo| Nagano, Osamu| Ujike, Yoshihito|
Abstract <p>In modern emergency and critical care, physicians tend to choose the mode of mechanical ventilation based on spontaneous breathing for the purpose of promoting discharge of pulmonary secretion and preventing atelectasis in patients with acute respiratory insufficiency. However, we often observe &#34;differences in recovery&#34; among patients treated using the same PSV settings beyond &#34;differences in individual characteristics.&#34; We evaluated the Pressure Support Ventilation (PSV) mode aiming to certify the difference among 7 representative mechanical ventilators using the Active Servo Lung 5000 (ASL5000) respiratory simulation system. The following parameters were measured: The time delay that resulted in the lowest inspiratory pressure from the point at which the ventilator recognized spontaneous breathing (TD), the lowest inspiratory airway pressure (cmH2O) generated prior to the initiation of PSV (DeltaPaw), the work of breathing while triggering required to achieve the lowest inspiratory negative pressure from the beginning of inspiratory support (WOBtrig), and the inspiratory work of breathing (WOBi). The mean TD of the Puritan-Bennett type 840 (PB840) was signifi cantly shorter than those of other ventilators (p0.01). The WOBtrig of the PB840 was significantly lower than those of others (p0.01). However, the WOBi values of the Servo-I and T-Bird were greater than the others, with the Evita series showing the smallest WOBi of the 7 ventilators tested. According to this simulation study using ASL 5000, we concluded that PB840 was the most rapid response ventilator, but the Evita series was the gentlest mechanical ventilator among 7 ventilators from the standpoint of the total work of breathing during the inspiration phase in the setting of PSV.</p>
Keywords work of breathing pressure support ventilation mechanical ventilation active servo lung (ASL5000)
Amo Type Original Article
Published Date 2008-04
Publication Title Acta Medica Okayama
Volume volume62
Issue issue2
Publisher Okayama University Medical School
Start Page 127
End Page 133
ISSN 0386-300X
NCID AA00508441
Content Type Journal Article
language 英語
File Version publisher
Refereed True
PubMed ID 18464889
Web of Sience KeyUT 000255297600009
JaLCDOI 10.18926/AMO/30748
FullText URL fulltext.pdf
Author Tamesue, Kiyokazu| Ichiba, Shingo| Nawa, Sugato| Shimizu, Nobuyoshi|
Abstract <p>This study was carried out to determine whether an extracorporeal membrane oxygenation (ECMO) support could be sufficiently conducted by the right ventricle alone from the viewpoint of the hemodynamics and blood gas state. Six infant dogs underwent a bypass between the left pulmonary artery and left atrium with an in-line oxygenator after a left pneumonectomy. Partial ECMO support was conducted simply by opening the circuit, and total ECMO support was conducted by ligating the right pulmonary artery. After the establishment of partial ECMO, approximately one-third of the right ventricular output was passively shunted through the bypass circuit, and the cardiac index and central venous pressure did not change. The mean pulmonary arterial pressures increased significantly. After a complete ligation of the right pulmonary artery, all 6 dogs survived for 12 h, but the cardiac output and blood pressure decreased significantly. The blood gas state was sufficiently maintained throughout the experiment. The results suggest the possibility of using the pumpless ECMO support. However, the flow resistance of the membrane oxygenator proved to still be too high for use in a total pumpless ECMO. Further studies on long-term ECMO and the development of a membrane oxygenator with a considerably low flow-resistance are needed.</p>
Keywords pumpless ECMO implantable artificial lung pulmonary bypass
Amo Type Article
Published Date 2006-06
Publication Title Acta Medica Okayama
Volume volume60
Issue issue3
Publisher Okayama University Medical School
Start Page 167
End Page 172
ISSN 0386-300X
NCID AA00508441
Content Type Journal Article
language 英語
File Version publisher
Refereed True
PubMed ID 16838045
Web of Sience KeyUT 000238503600004
JaLCDOI 10.18926/AMO/30728
FullText URL fulltext.pdf
Author Sato, Hitoshi| Taga, Ichiro| Kinoshita, Takahiro| Funakubo, Akio| Ichiba, Shingo| Shimizu, Nobuyoshi|
Abstract A prototype of an implantable artificial lung without a pump (Prototype II) has been tested. A commercially available membrane oxygenator, MENOX AL6000alpha R (Dainippon Ink and Chemicals, Inc., Tokyo, Japan), was used as a basic model. The packing density of the hollow fiber was decreased in order to achieve low resistance through the blood pathway. The configuration of its housing was also re-designed using computational fluid dynamics (CFD). The first prototype, known as Prototype I, was already tested in a 15 kg pig, which showed excellent gas exchange with normal hemodynamics. A second prototype, Prototype II, has a larger membrane surface area than Prototype I. The device was evaluated for resistance through the blood path and gas transfer rate in an in vitro setting by the single pass method using fresh bovine blood. The resistance through the blood path of Prototype II was 2.7+- 0.7 mmHg/(L/min) at Q = 5L/min. The oxygen (O2) transfer rate was 178 +- 5.3 ml/min at Q = 5 L/min, V/Q = 3, and the carbon dioxide (CO2) transfer rate was 149 +- 28 ml/min at Q = 5 L/min, V/Q = 2 (Q : blood flow rate, V : sweep oxygen flow rate through the artificial lung). For the purpose of implantation, this prototype showed sufficiently low resistance in the pulmonary circulation with reasonable gas exchange.
Keywords artificial lung low resistance gas exchange computer fluid dynamics
Amo Type Article
Published Date 2006-04
Publication Title Acta Medica Okayama
Volume volume60
Issue issue2
Publisher Okayama University Medical School
Start Page 113
End Page 119
ISSN 0386-300X
NCID AA00508441
Content Type Journal Article
language 英語
File Version publisher
Refereed True
PubMed ID 16680188
Web of Sience KeyUT 000237001900007