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Biomedical subjects

Yuji Fujino

Publications and source records attributed to Yuji Fujino.

At least 19 recordsLinked to original sources
PubMed2006

Effect of Ono-EI-600 elastase inhibitor on high-tidal-volume-induced lung injury in rats.

We tested the effect of Ono-EI-600, an elastase inhibitor that suppresses cytokine release, on ventilator-induced lung injury in a rat model. After Wistar rats (aged 8-11 weeks) were anesthetized and tracheostomized, they were randomly assigned to four groups: high tidal volume (V(T)) group (H group: n = 10) receiving peak inspiratory pressure (PIP) 30 cmH(2)O for 240 min; high V(T) with drug group (HD group: n = 10) receiving the same ventilation settings as H group and also intravenous infusion 10 mg x kg(-1) x h(-1) of Ono-EI-600 during the protocol; the lower V(T) group (L group: n = 5) receiving PIP 10 cmH(2)O for 240 min; and control group (C group: n = 5) receiving the same ventilation as L group for 30 min. The cytokine levels (IL-6 and CINC-1) in the bronchoalveolar lavage fluid (BALF) of the H group were significantly higher than those of the C and L groups (P < 0.05). However, for the H and HD groups, no differences were found in arterial blood gas data, cytokine levels in BALF, and histological injury scores. Our experiment provided no evidence that elastase inhibitor Ono-EI-600 protects against lung injury induced by high V(T) ventilation.

Animals↗
PubMed2006

Effect of peak inspiratory flow on gas exchange, pulmonary mechanics, and lung histology in rabbits with injured lungs.

PURPOSE: The aim of this study was to evaluate, using a rabbit model, the little-known effect of different levels of peak inspiratory flow on acutely injured lungs. METHODS: Fourteen male rabbits (body weight, 2,711 +/- 146 g) were anesthetized and their lungs were injured by alveolar overstretch with mechanical ventilation until Pa(O(2)) was reduced below 300 mmHg. Injured animals were randomly assigned to: the P group-to receive pressure-regulated volume-control ventilation (PRVCV; n = 7); and the V group-to receive volume-control ventilation (VCV; n = 7). Other ventilator settings were: fraction of inspired oxygen (FI(O(2)), 1.0; tidal volume, 20 ml x kg(-1); positive end-expiratory pressure (PEEP) 5 cmH(2)O; and respiratory rate, 20 min(-1). The animals were thus ventilated for 4 h. Throughout the protocol, ventilatory parameters and blood gas were measured every 30 min. After the protocol, the lung wet-to-dry ratio and histological lung injury score were evaluated in the excised lungs. RESULTS: Throughout the protocol, peak inspiratory flow and mean inspiratory flow values in the P group were significantly higher than those in the V group (26.7 +/- 5.0 l x min(-1) vs 1.2 +/- 0.2 l x min(-1), and 4.3 +/- 0.3 l x min(-1) vs 1.1 +/- 0.1 l x min(-1); P < 0.05). The wet-to-dry ratio in the P group was also significantly higher than that in the V group (7.7 +/- 0.9 vs 6.3 +/- 0.5; P < 0.05). More animals in the P group than in the V group had end-of-protocol Pa(O(2))/FI(O(2)) ratios below 200 mmHg (43% vs 0%; P = 0.06). CONCLUSION: In rabbits with injured lungs, high peak inspiratory flow with high tidal volume (V(T)) reduces the Pa(O(2))/FI(O(2)) ratio and increases the lung wet-to-dry ratio.

Animals↗
PubMed2006

Effect of humidifying devices on the measurement of tidal volume by mechanical ventilators.

PURPOSE: We hypothesized that expiratory tidal volume was underestimated, because a heat-moisture exchanger traps the expired vapor. We, therefore, designed patient and bench studies to investigate the accuracy of tidal volume monitoring. METHODS: In a patient study, applying two humidifying systems (a heat-moisture exchanger and a heated humidifier) and two tidal volumes (12 and 6 ml x kg(-1)) with a Servo ventilator 300, we recorded the displayed expiratory tidal volume and thoracic volume displacement, measured by respiratory inductive plethysmography. Temperature, relative humidity, and absolute humidity were measured at the airway opening and at the end of the expiratory limb. Using a model lung, we also tested three different ventilators (Puritan-Bennett 7200ae, Evita 4, and Servo ventilator 300) to investigate whether the effects of the heat-moisture exchanger and the heated humidifier on monitored tidal volume varied according to the brand of ventilator. RESULTS: With the use of the heat-moisture exchanger, the displayed expiratory tidal volume was significantly smaller, by 12%-14%, than that with the heated humidifier, although thoracic volume displacement was identical in the two systems. The temperature and absolute humidity at the end of the expiratory limb were significantly lower with the heat-moisture exchanger than with the heated humidifier. In the model lung study, we investigated the effects of different brands of ventilator on the expiratory tidal volume. A similar degree (8%-14%) of underestimation of tidal volume was observed with the heat-moisture exchanger, regardless of ventilator brand. CONCLUSION: Monitored expiratory tidal volume was underestimated by approximately 10%, when using a heat-moisture exchanger.

Adolescent↗
PubMed2006

Effect of a polymorphonuclear elastase inhibitor (sivelestat sodium) on acute lung injury after cardiopulmonary bypass: findings of a double-blind randomized study.

PURPOSE: We evaluated the effect of sivelestat sodium (SiV), a novel synthesized polymorphonuclear (PMN) elastase inhibitor, on acute lung injury (ALI) caused by cardiopulmonary bypass (CPB). METHODS: Fourteen patients who underwent cardiopulmonary surgery using CPB, followed by the development of both systemic inflammatory response syndrome (SIRS) and ALI, were treated with either 0.2 mg/kg per hour SiV (SiV group, n = 7) or saline (control group, n = 7) for 4 days from the time of arrival in the intensive care unit. RESULTS: The SiV group had a significantly lower ratio of serum PMN elastase and interleukin (IL)-8, a significantly lower ratio of the respiratory index, and a significantly higher ratio of PaO(2)/FiO(2) after 24 h of treatment than the control group. CONCLUSION: Sivelestat sodium suppressed the production of PMN elastase and IL-8, resulting in improved respiratory function in patients with ALI caused by CPB.

Acute Disease↗
PubMed2006

Regional blood flow in respiratory muscles during partial ventilatory assistance in rabbits.

We tested the hypothesis that even partial ventilatory assistance would reduce respiratory muscle blood flow to levels similar to those found during control mechanical ventilation (CMV). Three levels of pressure support ventilation (PSV) and 2 CMV settings were compared in 10 rabbits. PSV 0, 6, and 12 cm H2O, under continuous positive airway pressure mode, were applied, and then pressure control ventilation (PCV) values of 6 (36 breaths/min) and 12 cm H2O (18 per breaths/min) were applied to each CMV setting with a muscle relaxant. Using colored microspheres, we measured regional tissue blood flow in respiratory muscles, lower extremities, kidney, and liver. Regional tissue blood flow in the diaphragm during PSV6, PCV6, and PCV12 were less than those during PSV0. During PSV12, blood flow in the crural diaphragm was more than that during PCV12 and similar to that during PSV0. Whereas the transdiaphragmatic pressure of PSV6 was -0.8 +/- 1.6 cm H2O, that of PSV12 was -3.1 +/- 2.4 cm H2O. Inspiratory asynchrony, arising from an ineffective triggering effort, was observed in PSV12. The ventilatory settings did not affect blood flow of the lower extremities, liver, and kidney. In conclusion, ventilatory settings affected blood flow in the diaphragm. At certain PSV settings, blood flow in the diaphragm was minimal.

Animals↗
PubMed2005

Postoperative hyperbilirubinemia after implantation of left ventricular assist device is associated with poor postoperative liver perfusion.

Hyperbilirubinemia, a common complication associated with left ventricular assist device (LVAD) implantation, is evidence of liver dysfunction and is often a life-threatening problem after the implantation procedure. In this study we evaluated the relationship between hemodynamics after LVAD implantation and postoperative hyperbilirubinemia. Twenty-four patients who received LVADs at Osaka University Hospital between January 1994 and June 2002 were retrospectively reviewed. Patients were grouped according to the implanted LVAD: Group A (n = 4) Novacor, group B (n = 7) HeartMate 1000IP, group C (n = 13) Toyobo pneumatic pulsatile pump. Hemodynamic data and laboratory data, including total bilirubin on postoperative days (PODs) 1, 3, 7, and 14, were collected and statistically analyzed. In group C, the cardiac index (CI) on POD 1 was significantly lower (P < 0.01) than that for groups A and B. On PODs 3 and 7, total bilirubin levels in group C increased significantly over the preoperative value (P < 0.05) and were significantly higher than those in group A on POD 3 and higher than those in groups A and B on POD 7 (P < 0.05). Regression analysis of CI on POD 1 correlated significantly with total bilirubin on POD 7, as expressed by the formula y = 5.13/(x - 1.7)(0.719), where x is CI and y is total bilirubin (r(2) = 0.327, P < 0.05). Total bilirubin after LVAD implantation correlates with postoperative CI values. We suggest that it is essential to maintain the CI at the highest levels possible to avoid postoperative hyperbilirubinemia in LVAD patients.

Adult↗
PubMed2005

Time to change diagnostic criteria of ARDS: towards the disease entity-based subgrouping.

Because of high mortality and morbidity, acute respiratory distress syndrome (ARDS) continues to be one of the clinical challenges for intensivists. The diagnostic criteria for ARDS published by the American-European consensus conference were over simplified and made it possible to conduct large-scale randomized controlled trails (RCTs). Thus, many RCTs have been conducted in attempts to evaluate new treatment modalities, but many have reported negative results, in part because this definition was too broad to be used as diagnostic criteria. Pulmonary ARDS and extrapulmonary ARDS differ in terms of their morbidity and mortality with the presence of organ failure being an important risk factor for mortality in ARDS patients. The Classification of ARDS into several subgroups, which take the underlying disease into account, might limit the number of patients enrolled in an RCT. Where as this subgroup classification would enable selection of a homogeneous population of ARDS patients and may be a key to conducting more focused RCTs and, therefore, having more reliable results.

Humans↗
PubMed2005

Effects of gas leak on triggering function, humidification, and inspiratory oxygen fraction during noninvasive positive airway pressure ventilation.

OBJECTIVES: During noninvasive positive pressure ventilation (NPPV), the gas leak that commonly occurs around the mask can render NPPV ineffective. We evaluated the effects of gas leak on inspiratory trigger function during NPPV with bilevel pressure and ICU ventilators. In addition, we evaluated the effects of gas leak on fraction of inspired oxygen (Fio(2)) and humidification. METHODS: Air leak was created at the airway opening of a model lung by establishing several different-size holes in the circuit. During simulated spontaneous breathing, we evaluated inspiratory trigger performance of two bilevel pressure ventilators (BiPAP Vision and BiPAP S/T-D; Respironics; Murrysville, PA) and two ICU ventilators (Puritan-Bennett 7200ae and Puritan-Bennett 840; Tyco Healthcare; Mansfield, MA). Inspiratory delay time and inspiratory trigger pressure were analyzed. Fio(2) at the airway opening and inside the model lung were evaluated during BiPAP S/T-D ventilation at supplemental oxygen flows of 3, 6, 9, 12 and 15 L/min. Measured oxygen concentration was compared to mathematically predicted levels. Finally, using two heated humidifiers, we evaluated the effect of gas leak on humidification. RESULTS: The bilevel pressure ventilators triggered properly at all levels of gas leak, and inspiratory triggering was more effective than with the ICU ventilators. Delivered Fio(2) with the BiPAP S/T-D ventilator was affected by gas leak and could be predicted mathematically unless the gas leak was large. With large gas leaks, although relative humidity was maintained, absolute humidity decreased. CONCLUSION: Gas leak affected triggering of ICU ventilators, Fio(2) of the BiPAP S/T-D ventilator, and humidity with both types of humidifiers.

Equipment Design↗
PubMed2005

[A case of continuous infusion of milrinone during continuous venovenous hemofiltration causing high plasma concentration of milrinone].

A 79-year-old woman was undergoing chronic hemodyalysis. She received a continuous infusion of milrinone of 0.25 microg x kg(-1) x min(-1) for 77 hours, 0.2 microg x kg(-1) x min(-1) for 39 hours and 0.1 microg x kg(-1) x min(-1) for one hour due to heart failure after mitral valve repair. While receiving continuous infusion of milrinone, she was undergoing continuous venovenous hemofiltration. After infusion of milrinone for three days no arrhythmia was seen except atrial fibliration, but blood pressure remained low. After stopping infusion of milrinone, the plasma concentration of milrinone was 792.7 ng x ml(-1) (therapeutic plasma concentration: 100-200 ng x ml(-1)). Now few data are available regarding the pharmacokinetic of milrinone in patients with severe renal failure and during CVVH. Therefore we should design a dose modification for intravenous milrinone in renal failure patients.

Aged↗
PubMed2004

Effects of peak inspiratory flow on development of ventilator-induced lung injury in rabbits.

BACKGROUND: A lung-protecting strategy is essential when ventilating acute lung injury/acute respiratory distress syndrome patients. Current emphasis is on limiting inspiratory pressure and volume. This study was designed to investigate the effect of peak inspiratory flow on lung injury. METHODS: Twenty-four rabbits were anesthetized, tracheostomized, ventilated with a Siemens Servo 300, and randomly assigned to three groups as follows: 1) the pressure regulated volume control group received pressure-regulated volume control mode with inspiratory time set at 20% of total cycle time, 2) the volume control with 20% inspiratory time group received volume-control mode with inspiratory time of 20% of total cycle time, and 3) the volume control with 50% inspiratory time group received volume-control mode with inspiratory time of 50% of total cycle time. Tidal volume was 30 ml/kg, respiratory rate was 20 breaths/min, and positive end-expiratory pressure was 0 cm H2O. After 6 h mechanical ventilation, the lungs were removed for histologic examination. RESULTS: When mechanical ventilation started, peak inspiratory flow was 28.8 +/- 1.4 l/min in the pressure regulated volume control group, 7.5 +/- 0.5 l/min in the volume control with 20% inspiratory time group, and 2.6 +/- 0.3 l/min in the volume control with 50% inspiratory time group. Plateau pressure did not differ significantly among the groups. Gradually during 6 h, Pao2 in the pressure regulated volume control group decreased from 688 +/- 39 to a significantly lower 304 +/- 199 mm Hg (P < 0.05) (mean +/- SD). The static compliance of the respiratory system for the pressure regulated volume control group also ended significantly lower after 6 h (P < 0.05). Wet to dry ratio for the pressure regulated volume control group was larger than for other groups (P < 0.05). Macroscopically and histologically, the lungs of the pressure regulated volume control group showed more injury than the other groups. CONCLUSION: When an injurious tidal volume is delivered, the deterioration in gas exchange and respiratory mechanics, and lung injury appear to be marked at a high peak inspiratory flow.

Air Pressure↗
PubMed2003

Does the tube-compensation function of two modern mechanical ventilators provide effective work of breathing relief?

OBJECTIVE: An endotracheal tube (ETT) imposes work of breathing on mechanically ventilated patients. Using a bellows-in-a-box model lung, we compared the tube compensation (TC) performances of the Nellcor Puritan-Bennett 840 ventilator and of the Dräger Evita 4 ventilator. MEASUREMENTS AND RESULTS: Each ventilator was connected to the model lung. The respiratory rate of the model lung was set at 10 breaths/min with 1 s inspiratory time. Inspiratory flows were 30 or 60 l/min. A full-length 8 mm bore ETT was inserted between the ventilator circuit and the model lung. The TC was set at 0%, 10%, 50%, and 100% for both ventilators. Pressure was monitored at the airway, the trachea, and the pleura, and the data were recorded on a computer for later analysis of the delay time, of the inspiratory trigger pressure, and of the pressure-time product (PTP). The delay time was calculated as the time between the start of inspiration and minimum airway pressure, and the inspiratory trigger pressure was defined as the most negative pressure level. The same measurements were performed under pressure support ventilation of 4 and 8 cmH2O. The PTP increased according to the magnitude of inspiratory flow. Even with 100% TC, neither ventilator could completely compensate for the PTP imposed by the ETT. At 0% TC the PTP tended to be less with the Nellcor Puritan-Bennett 840 ventilator, while at 100% TC the PTP tended to be less with the Dräger Evita 4 ventilator. A small amount of pressure support can be equally effective to reduce the inspiratory effort compared with the TC. CONCLUSION: Although both ventilators provided effective TC, even when set to 100% TC they could not entirely compensate for a ventilator and ETT-imposed work of breathing. The effect of TC is less than that of pressure support ventilation. Physicians should be aware of this when using TC in weaning trials.

Humans↗
PubMed2003

Intrahospital transport of critically ill patients using ventilator with patient-triggering function.

OBJECTIVE: To compare a new transport ventilator to manual ventilation in terms of maintaining the respiratory and hemodynamic levels of critically ill patients. DESIGN: Prospective, randomized, single-center study. SETTING: ICU in a university hospital. PATIENTS: A total of 16 patients (22 transports) who were spontaneously breathing and required ventilatory assistance on excursions from the ICU. METHODS: For each transport, the patient was randomly assigned to receive either manual ventilation (group M) or mechanical ventilation (group V). For transports in group V, the ventilators were set the same as in the ICU. Respiratory and hemodynamic variables were measured 30 min before transport (T(0)), on arrival at the site of procedure (T(1)), on return to the ICU (T(2)), and 30 min after return the ICU (T(3)). RESULTS: After transport, five patients in group M showed a significant deterioration in PaO(2)/fraction of inspired oxygen ratio, while one patient in group V showed deterioration (p = 0.056). The mean (+/- SD) respiratory rate in group M at T(2) (32 +/- 9 breaths/min) was significantly higher (p < 0.001) than at T(0) (19 +/- 6 breaths/min) and also was higher (p < 0.01) than in group V at T(2) (19 +/- 6 breaths/min). The mean tidal volume and positive end-expiratory pressure in group M at T(2) showed significantly larger variation (p < 0.05 and p < 0.001, respectively) than in group V. CONCLUSIONS: The transport ventilator that was recently approved by the US Food and Drug Administration reliably provides more stable ventilatory support than does manual ventilation. Generally, the use of this transport ventilator for intrahospital transport is preferable to manual ventilation.

Critical Illness↗
PubMed2003

Spontaneously breathing lung model comparison of work of breathing between automatic tube compensation and pressure support.

INTRODUCTION: Automatic tube compensation (ATC), a new ventilation mode that compensates for the work of breathing imposed by endotracheal tube resistance, recently became commercially available. METHODS: We conducted a laboratory study with a lung model and a Nellcor Puritan Bennett 840 ventilator to compare ATC and pressure-support ventilation (PSV). A bellows-in-a-box lung model simulated spontaneous breathing with the following settings: respiratory rate 10 breaths/min, inspiratory time 1.0 s, peak inspiratory flow 60 L/min without connecting to the ventilator and endotracheal tube (ETT). At each ETT size (5, 6, 7, 8 and 9 mm inner diameter) 100% ATC was compared with pressure support (PS) of 0, 2, 4, 6, 8, and 10 cm H(2)O at positive end-expiratory pressure (PEEP) of 0 and 5 cm H(2)O. The negative deflection (PI) of the "alveolar" pressure (ie, pressure inside the bellows, P(alv)) and the delay time were measured. The PI and total pressure-time product (PTP(tot)) integrated from P(alv) were analyzed. PTP(tot) was subdivided into PTP(trig) (the PTP from the beginning of inspiration to the minimum P(alv)) and PTP(supp) (the PTP from the minimum P(alv) to the return to baseline P(alv)). RESULTS: At PEEP of 0 cm H(2)O: with ETTs of 5, 6, and 7 mm the PI values with ATC corresponded to PS of 0-4 cm H(2)O; with the 8-mm ETT the PI values corresponded to PS of 0 cm H(2)O; with the 9-mm ETT the PI values corresponded to PS of 0-2 cm H(2)O. At PEEP of 5 cm H(2)O, with all ETT sizes the PI values corresponded to PS of 0 cm H(2)O. PTP(tot) and PTP(supp) of ATC corresponded to: PS of 2-4 cm H(2)O with the 5-mm ETT; PS of 2 cm H(2)O with the 6-mm ETT; PS of 0-2 cm H(2)O with the 7-mm ETT; and PS of 0 cm H(2)O with the 8- and 9-mm ETTs, at PEEP of 0 cm H(2)O. PEEP of 5 cm H(2)O was not tested for PTP. PTP(trig) with ATC showed comparable or greater values with each size of ETT. CONCLUSIONS: ATC with a Nellcor Puritan Bennett 840 ventilator provided inspiratory ventilatory support corresponding to PS of <or= 4 cm H(2)O, depending on ETT size, which was not enough to compensate for the work of breathing imposed by the ETT.

Humans↗
PubMed2003

Using a vortex mixer for testicular sperm collection.

OBJECTIVE: To evaluate 2 methods of processing testicular tissue for the retrieval of viable sperm from men with nonobstructive azoospermia. STUDY DESIGN: Fresh testicular tissue was obtained from nonobstructive azoospermia patients using a biopsy needle. The specimens were divided into 2 fractions. All specimens were minced and immersed in human tubal fluid (HTF). The first fraction was filtered through a nylon filter and incubated for 3 hours. The supernatant was centrifuged, resuspended in HTF and analyzed. The second fraction was immediately vortexed for 5 minutes and filtered through a nylon filter. The supernatant was centrifuged, resuspended in HTF and analyzed. RESULTS: Spermatozoa were obtained in 13 of 24 cases (54.2%) using the vortex method and in 5 of 24 cases (20.8%) with the nylon filter method. CONCLUSION: The vortex mixing method may be a better option than the conventional method for processing testicular tissue for sperm collection.

Adult↗
PubMed2002

Vascular endothelial growth factor concentrations in follicular fluid obtained from IVF-ET patients: a comparison of hMG, clomiphene citrate, and natural cycle.

PURPOSE: Evaluation of vascular endothelial growth factor (VEGF) concentrations of follicular fluid (FF) in accordance with an ovarian stimulation protocol and ovarian response. METHODS: The subjects of this study were 38 patients undergoing IVF-ET in our hospital. They were divided into three groups according to ovarian stimulation protocols; Group 1: hMG cycles (n = 19), Group 2: clomiphene citrate cycles (n = 10), Group 3: natural cycles (n = 9). They reclassified into three groups according to the number of oocytes harvested. VEGF concentration was measured in FF, employing ELISAs. RESULTS: Group 1 shows lower VEGF concentrations in FF than Group 2 or Group 3. Excluding high responders from Group 1, no difference was found among these three groups. As for the reclassified groups, group of highest number of oocytes havested showed lowest VEGF concentrations in FF. CONCLUSIONS: VEGF concentrations in FF might negatively correlate with the number of follicles, irrespective of the ovulation induction protocol.

Adult↗
PubMed2002

Validity of gastric intramucosal pH (pHi) for circulatory evaluation in pediatric patients.

OBJECTIVE: To determine if the measurement of gastric intramucosal pH (pHi) is useful for evaluation of circulatory status of critically ill pediatric patients. DESIGN: Prospective clinical study. SETTING: General intensive care unit in a university hospital. PATIENTS: Seven pediatric patients (mean age: 2 y.o.); six post-cardiac surgery, one receiving barbiturate therapy. INTERVENTIONS: Tonometric catheters were placed via nasogastric approach. pHi was measured after confirmation of the catheter position by X-ray. MEASUREMENTS AND MAIN RESULTS: Saturation of venous blood oxygen (SvO2), arterial keton body ratio (AKBR), serum lactate level and pHi were evaluated simultaneously. No patients survived with pHi below 7.22; pHi above 7.11 significantly correlated with SvO2 values (r = 0.814, p < 0.001); pHi below 7.11 did not show any significant correlation with SvO2. Whereas SvO2 values of under 40% were distributed in the pHi range from 7.11 to 7.19, pHi below 7.11 occurred when SvO2 values were more than 40%. AKBR and serum lactate level did not correlate with pHi. CONCLUSION: pHi can be a useful parameter for evaluating the circulatory status of critically ill pediatric patients; it allows reliable evaluation of splanchnic and peripheral perfusion.

Child↗