中性液への変更によって腹膜刺激症状が消失したCAPDの一例

Article長野県透析研究会誌 25(1): 97-98(2002)journal articl

血漿交換(PE)が著効したMPO-ANCA関連肺腎症候群の1例

Article長野県透析研究会誌 26(1): 51-54(2003)journal articl

PERSonality, Ehical, and PROfessional quality of life in Pediatric/Adult Intensive Nurses study: PERSEPRO PAIN study

BackgroundThe World Health Organization included burnout syndrome criteria that reduce both professional quality of life and work satisfaction in its 11th Revision of the International Classification of Diseases in 2019 while nursing bodies have issued action calls to prevent burnout syndrome. Despite this, the effect of social factors, personality traits and cross-interaction on professional quality of life is still unclear.AimTo reveal the association between ethical climate, personal trait and professional quality of life.MethodAn online survey of registered nurses working in adult, pediatric or both ICUs. We used the ten-item personality measure based on The Big Five theory and Type-D personality Scale-14 then measured the ethical climate with the Hospital Ethical Climate Survey and the professional domains of burnout syndrome, secondary traumatic stress and compassion satisfaction by the Professional Quality of Life Scale Version 5 simultaneously. Multivariate analysis confirmed the triangular association of hospital ethical climate, personality traits and professional quality of life.ResultWe enrolled 310 participants from September 2019 to February 2020. Mean age was 33.1 years (± 5.9) and about 70% were female. In the multivariate analysis, neuroticism (p = 0.03, p = 0.01) and Type D personality (both of p<0.01) were associated with burnout syndrome and secondary traumatic stress while agreeableness (p<0.01) was associated with secondary traumatic stress. Conversely, extraversion (p = 0.01), agreeableness (p<0.01) and openness (p<0.01) were associated with compassion satisfaction. We also observed interactions between hospital ethical climate and conscientiousness (p = 0.01) for burnout syndrome and secondary traumatic stress. Neuroticism was related to (p<0.01) BOS and compassion satisfaction while Type D personality (p<0.01) correlated with burnout syndrome and secondary traumatic stress.ConclusionHospital ethical climate strongly affects professional quality of life in nurses with specific personality traits. Therefore, it is important to maintain an ethical hospital climate, considering individual personalities to prevent burnout syndrome

Down Syndrome Reduces the Sedative Effect of Midazolam in Pediatric Cardiovascular Surgical Patients

Down syndrome (DS) is frequently comorbid with congenital heart disease and has recently been shown to reduce the sedative effect of benzodiazepine (BDZ)-class anesthesia but this effect in a clinical setting has not been studied. Therefore, this study compared midazolam sedation after heart surgery in DS and normal children. We retrospectively reviewed patient records in our pediatric intensive care unit (PICU) of pediatric cardiovascular operations between March 2015 and March 2018. We selected five days of continuous post-operative data just after termination of muscle relaxants. Midazolam sedation was estimated by Bayesian inference for generalized linear mixed models. We enrolled 104 patients (average age 26 weeks) of which 16 (15%) had DS. DS patients had a high probability of receiving a higher midazolam dosage and dexmedetomidine dosage over the study period (probability = 0.99, probability = 0.97) while depth of sedation was not different in DS patients (probability = 0.35). Multi regression modeling included severity scores and demographic data showed DS decreases midazolam sedation compared with controls (posterior OR = 1.32, 95% CrI = 1.01–1.75). In conclusion, midazolam dosages should be carefully adjusted as DS significantly decreases midazolam sedative effect in pediatric heart surgery patients

Type D personality is a predictor of prolonged acute brain dysfunction (delirium/coma) after cardiovascular surgery

BackgroundPrevious studies have shown a relationship between delirium and depressive symptoms after cardiac surgery with distress personalities linking to negative surgical outcomes. The aim of the present study is to further investigate the association between patients with Type D (distressed) personality with regards to delirium after cardiac surgery.MethodsWe conducted a consecutive-sample observational cohort pilot study with an estimated 142 patients needed. Enrollment criteria included patients aged ≥18 years who were undergoing planned cardiovascular, thoracic and abdominal artery surgery between October 2015 to August 2016 at the University of Tsukuba Hospital, Japan. All patients were screened by Type-D Personality Scale-14 (DS14) as well as the Hospital Anxiety and Depression Scale (HADS) the day before surgery. Following surgery, daily data was collected during recovery and included severity of organ dysfunction, sedative/analgesic exposure and other relevant information. We then evaluated the association between Type D personality and delirium/coma days (DCDs) during the 7-day study period. We applied regression and mediation modeling for this study.ResultsA total of 142 patients were enrolled in the present study and the total prevalence of delirium was found to be 34% and 26% of the patients were Type D. Non-Type D personality patients experienced an average of 1.3 DCDs during the week after surgery while Type D patients experienced 2.1 days over the week after surgery. Multivariate analysis showed that Type D personality was significantly associated with increased DCDs (OR:2.8, 95%CI:1.3–6.1) after adjustment for depressive symptoms and clinical variables. Additionally, there was a significant Type D x depression interaction effect (OR:1.7, 95% CI:1.2–2.2), and depressive symptoms were associated with DCDs in Type D patients, but not in non-Type D patients. Mediation modeling showed that depressive symptoms partially mediated the association of Type D personality with DCDs (Aroian test =0.04).ConclusionsType D personality is a prognostic predictor for prolonged acute brain dysfunction (delirium/coma) in cardiovascular patients independent from depressive symptoms and Type D personality-associated depressive symptoms increase the magnitude of acute brain dysfunction.Research articl

Association between fluid overload and delirium/coma in mechanically ventilated patients

AimSeveral studies have shown an association between fluid overload (FO) and mortality or duration of mechanical ventilation in critically ill patients. However, the association between FO and delirium duration remains unclear.MethodsThis retrospective observational cohort study was undertaken at University of Tsukuba Hospital (Tsukuba, Japan) from April 2015 to March 2017. Mechanically ventilated patients who stayed in the intensive care unit for more than 7 days were eligible for inclusion. Univariate analysis was carried out with the Mann–Whitney U-test for continuous variables and Fisher’s exact test for categorical variables. A multivariate proportional odds logistic regression model was used to evaluate the association between FO and delirium/coma days (DCDs) during the 7-day study period.ResultsA total of 118 patients were included and divided into FO and non-FO groups. Fluid overload occurred in 40% of patients. The FO group had a higher APACHE II score than the non-FO group (19 [16–26] versus 23 [20–29], P = 0.017). Cumulative fluid balance at day 3 was higher in the FO group (3,238 [281–6,530] versus 7,886 [4,106–10,631], P < 0.001). Delirium days within 7 days was longer in the FO group (1 [0–3] versus 2 [1–3], P = 0.048) and DCDs was longer in the FO group (4 [1–5] versus 6 [3–7], P = 0.002). After adjusting for covariates, there were significant associations between FO and DCDs (odds ratio, 2.16; 95% confidence interval, 1.05–4.47).ConclusionsOur findings suggest that FO is associated with increased DCDs in mechanically ventilated patients

CROUZON DISEASE COMPLICATED WITH CONGENITAL CORNEAL OPACITY AND SEVERE DYSPNEA DUE TO UPPER AIRWAY STENOSIS

A case of Crouzon disease complicated with congenital corneal opacity and severe dyspnea due to upper airway stenosis is reported. A male infant with a birth weight of 2.960 g and a gestational age of 38 weeks and 6 days, was admitted to the neonatal intensive care unit (NICU) due to odd facial features and recurrent severe cyanosis. He exhibited a bulging forehead, exophthalmos and corneal opacity, however, there was no syndactyly. X-ray films of the skull demonstrated early synostosis in all sutures and digital impressions, and he was diagnosed with Crouzon disease. The case was complicated by incomplete dislocations of both elbow joints, synostosis between the third and forth cervical vertebrae and atrial septal defect. We began intermittent mandatory ventilation soon after admission because severe cyanosis with bradycardia recurred. Computed tomography and X-ray films revealed severe stenosis in the oropharyngolaryngeal cavity, and tracheotomy was performed at 44 days old. Craniectomy, keratoplasty and ventriculo-peritoneal shunt surgery were performed at 64 days, 136 days. and 318 days, respectively. He left NICU at 318 days. However, respitatory infection reccurred frequently and he died due to bronchopneumonia at 387 days. Our case seems to be a very rare and severe case of Crouzon disease

急性期に診断に難渋した発作性寒冷血色素尿症

症例は3 歳男児，上気道症状を伴う先行感染があり，その後に黒色尿・貧血・黄疸を認めた．Hb3.6 g/dL，LDH2866 IU/L，I-Bil 3.9 mg/dL，直接Coombs試験は補体のみ陽性であり自己免疫性溶血性貧血が疑われ当院紹介受診，入院となった．寒冷凝集素症（CAD），発作性寒冷血色素尿症（PCH）の鑑別目的で初診時および第4 病日にDonath-Landsteiner 試験（DL試験）を施行したが，溶血が強く判定不能であった．プレドニゾロンを1mg/kg/dayで開始し，症状は軽快した．第8 病日にDL試験を再度施行し結果は陽性であり，PCHと診断した．プレドニゾロンを速やかに漸減し，第10病日に退院した．以降は外来にて防寒指導を行い，症状再燃なく終診となった．急性期は溶血所見が強く，DL試験の判定が困難になることがあり，時期を変えて数回実施することが必要であることが示唆された

Development of the Japanese version of the State Behavioral Scale for critically ill children

AimsThe State Behavioral Scale (SBS) was developed to assess sedation states, including agitation, in pediatric patients on mechanical ventilation. The purpose of this study was to determine the reliability and validity of a back-translated Japanese version of the SBS.MethodsTranslation was done by the back-translation method followed by a prospective study in a Japanese intensive care unit. For reliability, a nurse/researcher pair evaluated SBS along eight dimensions (respiratory drive, response to ventilation, coughing, best response to stimulation, attentiveness to care provider, tolerance to care, consolability, and movement after consoled). For validity, SBS scores were compared to the Richmond Agitation–Sedation Scale and a visual analog scale (VAS).ResultsThe original author approved the back-translated SBS. Thirty-one patients aged 0 weeks to 8 years were evaluated from 59 total critical pediatric patient encounters. The researcher and nurse SBS scores demonstrated excellent inter-rater reliability (weighted κ = 0.96, 95% CI 0.92–0.99). In addition, there was a very strong correlation between the researcher and nurse VAS scores (ρ = 0.80, P < 0.001). Weighted kappa coefficients for the eight dimensions ranged from 0.71 (95% confidence interval, 0.55–0.88; consolability) to 0.89 (95% confidence interval, 0.80–0.98; best response to stimulation). In validity testing, nurse SBS and nurse VAS scores were strongly correlated (ρ = 0.80, P < 0.001) with the researcher SBS and researcher Richmond Agitation–Sedation Scale scores (ρ = 0.91, P < 0.001).ConclusionThis study suggests that our Japanese version of the SBS is valid and reliable for evaluating sedation for critically ill children.Original Articl