- 著者
- Ryuta Nakashima Toru Hifumi Kenya Kawakita Tomoya Okazaki Satoshi Egawa Akihiko Inoue Ryutaro Seo Nobuhiro Inagaki Yasuhiro Kuroda
- 出版者
- 日本循環器学会
- 雑誌
- Circulation Journal (ISSN:13469843)
- 巻号頁・発行日
- pp.CJ-16-1006, (Released:2017-02-24)
- 参考文献数
- 133
- 被引用文献数
- 13
The discussion of neurocritical care management in post-cardiac arrest syndrome (PCAS) has generally focused on target values used for targeted temperature management (TTM). There has been less attention paid to target values for systemic and cerebral parameters to minimize secondary brain damage in PCAS. And the neurologic indications for TTM to produce a favorable neurologic outcome remain to be determined. Critical care management of PCAS patients is fundamental and essential for both cardiologists and general intensivists to improve neurologic outcome, because definitive therapy of PCAS includes both special management of the cause of cardiac arrest, such as coronary intervention to ischemic heart disease, and intensive management of the results of cardiac arrest, such as ventilation strategies to avoid brain ischemia. We reviewed the literature and the latest research about the following issues and propose practical care recommendations. Issues are (1) prediction of TTM candidate on admission, (2) cerebral blood flow and metabolism and target value of them, (3) seizure management using continuous electroencephalography, (4) target value of hemodynamic stabilization and its method, (5) management and analysis of respiration, (6) sedation and its monitoring, (7) shivering control and its monitoring, and (8) glucose management. We hope to establish standards of neurocritical care to optimize brain function and produce a favorable neurologic outcome.
- 著者
- Ryuta Nakashima Toru Hifumi Kenya Kawakita Tomoya Okazaki Satoshi Egawa Akihiko Inoue Ryutaro Seo Nobuhiro Inagaki Yasuhiro Kuroda
- 出版者
- 日本循環器学会
- 雑誌
- Circulation Journal (ISSN:13469843)
- 巻号頁・発行日
- vol.81, no.4, pp.427-439, 2017-03-24 (Released:2017-03-24)
- 参考文献数
- 133
- 被引用文献数
- 13
The discussion of neurocritical care management in post-cardiac arrest syndrome (PCAS) has generally focused on target values used for targeted temperature management (TTM). There has been less attention paid to target values for systemic and cerebral parameters to minimize secondary brain damage in PCAS. And the neurologic indications for TTM to produce a favorable neurologic outcome remain to be determined. Critical care management of PCAS patients is fundamental and essential for both cardiologists and general intensivists to improve neurologic outcome, because definitive therapy of PCAS includes both special management of the cause of cardiac arrest, such as coronary intervention to ischemic heart disease, and intensive management of the results of cardiac arrest, such as ventilation strategies to avoid brain ischemia. We reviewed the literature and the latest research about the following issues and propose practical care recommendations. Issues are (1) prediction of TTM candidate on admission, (2) cerebral blood flow and metabolism and target value of them, (3) seizure management using continuous electroencephalography, (4) target value of hemodynamic stabilization and its method, (5) management and analysis of respiration, (6) sedation and its monitoring, (7) shivering control and its monitoring, and (8) glucose management. We hope to establish standards of neurocritical care to optimize brain function and produce a favorable neurologic outcome.
- 著者
- Toru Hifumi Hayato Yoshioka Kazunori Imai Toshihiro Tawara Takashi Kanemura Eiju Hasegawa Hiroshi Kato Yuichi Koido
- 出版者
- The Japanese Society of Intensive Care Medicine
- 雑誌
- 日本集中治療医学会雑誌 (ISSN:13407988)
- 巻号頁・発行日
- vol.18, no.4, pp.607-610, 2011-10-01 (Released:2012-03-20)
- 参考文献数
- 18
- 被引用文献数
- 1 1
The cases of intake of organophosphate pesticides reported in Japan are mainly due to oral ingestion associated with attempted suicides. We report a case of organophosphate pesticide poisoning in which percutaneous absorption was suspected to be the cause. A 61-year-old woman was brought to our hospital because of consciousness disturbance. She was found lethargic, lying in the bathroom, by her husband. She had a significant medical history of hypertension. On admission, her Glasgow coma scale (GCS) score was 14/15. Her vital signs were as follows: body temperature, 35.3°C; blood pressure, 185/102 mmHg; heart rate, 106 /min; and respiratory rate, 23 /min. Her oxygen saturation was 100%. Her pupils were 2 mm in diameter, equal in size, round, and reactive. The rest of the examination was unremarkable. Chest X-ray, head CT, and head MRI were performed, but failed to identify the cause of the consciousness disturbance. Three hours after arrival, her oxygen saturation level had fallen and diaphoresis, miosis, and lacrimation had developed, while she was intubated under sedation. Prior to tracheal intubation, we asked her whether she had taken any organophosphate agent, which she denied. No organophosphate smell was detected from the endotracheal tube. Nine hours after arrival, her cholinesterase level was reported to be 11 IU/l, and we could finally confirm the diagnosis. Pralidoxime and atropine therapy was accordingly started. Seventeen hours after arrival, her family brought bottles of pesticide (smithion®) to the hospital. It transpired that she had handled this organophosphate pesticide without wearing gloves, and that earlier she had received abrasions to her hands. Therefore, it was assumed that the organophosphate was easily absorbed through her skin. Critical care physicians should bear in mind that whenever they see patients with consciousness disturbance, percutaneously absorbed organophosphate poisoning could be one of the causes.