ICUで術後を診て，麻酔も上手くなろう

「ICUで術後を診るようになって，麻酔も上手くなった」．これは私が所属する横浜市大で，数カ月のICU研修を終えた若手からよく聞く言葉である．術後ICUで患者を診る側に立って，最適な麻酔管理を考える．逆に手術中の麻酔科医の立場から，ICUに適切な術後管理を提案する．手術室の狭いエビデンスにとらわれず，周術期における患者のclinical courseを俯瞰した輸液戦略や呼吸管理を提供する．手術麻酔のみならず術後管理にも精通し，スムーズな周術期管理を提供することは麻酔科医にとって重要な使命である．本稿では麻酔とICU，両方を知る立場から，Pros & Consを通じてシームレスでインタラク...

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Published in日本臨床麻酔学会誌 Vol. 41; no. 4; pp. 388 - 398
Main Authors 野村, 岳志, 出井, 真史
Format Journal Article
LanguageJapanese
Published 日本臨床麻酔学会 15.07.2021
Subjects
双方向性
周術期管理
集中治療
麻酔
Online AccessGet full text
ISSN0285-4945
1349-9149
DOI10.2199/jjsca.41.388

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Abstract 「ICUで術後を診るようになって，麻酔も上手くなった」．これは私が所属する横浜市大で，数カ月のICU研修を終えた若手からよく聞く言葉である．術後ICUで患者を診る側に立って，最適な麻酔管理を考える．逆に手術中の麻酔科医の立場から，ICUに適切な術後管理を提案する．手術室の狭いエビデンスにとらわれず，周術期における患者のclinical courseを俯瞰した輸液戦略や呼吸管理を提供する．手術麻酔のみならず術後管理にも精通し，スムーズな周術期管理を提供することは麻酔科医にとって重要な使命である．本稿では麻酔とICU，両方を知る立場から，Pros & Consを通じてシームレスでインタラクティブな麻酔科医と集中治療医の姿を探ってみたい．
AbstractList [要旨] 「ICUで術後を診るようになって, 麻酔も上手くなった」. これは私が所属する横浜市大で, 数カ月のICU研修を終えた若手からよく聞く言葉である. 術後ICUで患者を診る側に立って, 最適な麻酔管理を考える. 逆に手術中の麻酔科医の立場から, ICUに適切な術後管理を提案する. 手術室の狭いエビデンスにとらわれず, 周術期における患者のclinical courseを俯瞰した輸液戦略や呼吸管理を提供する. 手術麻酔のみならず術後管理にも精通し, スムーズな周術期管理を提供することは麻酔科医にとって重要な使命である. 本稿では麻酔とICU, 両方を知る立場から, Pros & Consを通じてシームレスでインタラクティブな麻酔科医と集中治療医の姿を探ってみたい.
「ICUで術後を診るようになって，麻酔も上手くなった」．これは私が所属する横浜市大で，数カ月のICU研修を終えた若手からよく聞く言葉である．術後ICUで患者を診る側に立って，最適な麻酔管理を考える．逆に手術中の麻酔科医の立場から，ICUに適切な術後管理を提案する．手術室の狭いエビデンスにとらわれず，周術期における患者のclinical courseを俯瞰した輸液戦略や呼吸管理を提供する．手術麻酔のみならず術後管理にも精通し，スムーズな周術期管理を提供することは麻酔科医にとって重要な使命である．本稿では麻酔とICU，両方を知る立場から，Pros & Consを通じてシームレスでインタラクティブな麻酔科医と集中治療医の姿を探ってみたい．
Author 出井, 真史
野村, 岳志
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References 27) Safdar N, Dezfulian C, Collard HR, et al.：Clinical and economic consequences of ventilator-associated pneumonia：a systematic review. Crit Care Med 33：2184-2193, 2005
1) CoBaTrICE：Competency-Based Training in Intensive Care Medicine in Europe.〈http://www.cobatrice.org/en/index.asp〉（2021.3.27閲覧）
3) Lobo DN, Bostock KA, Neal KR, et al.：Effect of salt and water balance on recovery of gastrointestinal function after elective colonic resection：a randomised controlled trial. Lancet 359：1812-1818, 2002
16) Reinhart K, Bloos F, König F, et al.：Reversible decrease of oxygen consumption by hyperoxia. Chest 99：690-694, 1991
20) Volk T, Peters J, Sessler DI：The WHO recommendation for 80％ perioperative oxygen is poorly justified. Anaesthesist 66：227-229, 2017
6) Wuethrich PY, Burkhard FC, Thalmann GN, et al.：Restrictive deferred hydration combined with preemptive norepinephrine infusion during radical cystectomy reduces postoperative complications and hospitalization time：a randomized clinical trial. Anesthesiology 120：365-377, 2014
22) Jaber S, Chanques G, Matecki S, et al.：Post-extubation stridor in intensive care unit patients. Risk factors evaluation and importance of the cuff-leak test. Intensive Care Med 29：69-74, 2003
24) Miller RL, Cole RP：Association between reduced cuff leak volume and postextubation stridor. Chest 110：1035-1040, 1996
31) Bouza E, Jesús Pérez M, Muñoz P, et al.：Continuous aspiration of subglottic secretions in the prevention of ventilator-associated pneumonia in the postoperative period of major heart surgery. Chest 134：938-946, 2008
33) 日本版・集中治療室における成人重症患者に対する痛み・不穏・せん妄管理のための臨床ガイドライン〈https://www.jsicm.org/pdf/2015-J-PAD-guideline.pdf〉（2021.3.27閲覧）
18) Meyhoff CS, Jorgensen LN, Wetterslev J, et al.：Increased long-term mortality after a high perioperative inspiratory oxygen fraction during abdominal surgery：follow-up of a randomized clinical trial. Anesth Analg 115：849-854, 2012
26) Cook DJ, Walter SD, Cook RJ, et al：Incidence of and risk factors for ventilator-associated pneumonia in critically ill patients. Ann Intern Med 129：433-440, 1998
29) Lorente L, Blot S, Rello J：New issues and controversies in the prevention of ventilator-associated pneumonia. Am J Respir Crit Care Med 182：870-876, 2010
13) Allegranzi B, Zayed B, Bischoff P, et al.：New WHO recommendations on intraoperative and postoperative measures for surgical site infection prevention：an evidence-based global perspective. Lancet Infect Dis 16：e288-e303, 2016
2) Chappell D, Jacob M, Hofmann-Kiefer K, et al.：Antithrombin reduces shedding of the endothelial glycocalyx following ischaemia/reperfusion. Cardiovasc Res 83：388-396, 2009
25) Kuriyama A, Umakoshi N, Sun R：Prophylactic Corticosteroids for Prevention of Postextubation Stridor and Reintubation in Adults：A Systematic Review and Meta-analysis. Chest 151：1002-1010, 2017
19) Kurz A, Fleischmann E, Sessler DI, et al.：Effects of supplemental oxygen and dexamethasone on surgical site infection：a factorial randomized trial. Br J Anaesth 115：434-443, 2015
17) Meyhoff CS, Wetterslev J, Jorgensen LN, et al.：Effect of high perioperative oxygen fraction on surgical site infection and pulmonary complications after abdominal surgery：the PROXI randomized clinical trial. JAMA 302：1543-1550, 2009
23) Wittekamp BHJ, van Mook WNKA, Tjan DHT, et al.：Clinical review：post-extubation laryngeal edema and extubation failure in critically ill adult patients. Crit Care 13：233, 2009
9) Michard F：Changes in arterial pressure during mechanical ventilation. Anesthesiology 103：419-428, 2005
21) François B, Bellissant E, Gissot V, et al.：12-h pretreatment with methylprednisolone versus placebo for prevention of postextubation laryngeal oedema：a randomised double-blind trial. Lancet 369：1083-1089, 2007
28) 人工呼吸関連肺炎予防バンドル　2010改訂版〈https://www.jsicm.org/pdf/2010VAP.pdf〉（2021.3.27閲覧）
15) Barbateskovic M, Schjørring OL, Russo Krauss S, et al.：Higher versus lower fraction of inspired oxygen or targets of arterial oxygenation for adults admitted to the intensive care unit. Cochrane Database Syst Rev 2019：CD012631, 2019
4) Nisanevich V, Felsenstein I, Almogy G, et al.：Effect of intraoperative fluid management on outcome after intraabdominal surgery. Anesthesiology 103：25-32, 2005
8) Calvo-Vecino JM, Ripollés-Melchor J, Mythen MG, et al.：Effect of goal-directed haemodynamic therapy on postoperative complications in low-moderate risk surgical patients：a multicentre randomised controlled trial（FEDORA trial）. Br J Anaesth 120：734-744, 2018
7) Walsh M, Devereaux PJ, Garg AX, et al.：Relationship between intraoperative mean arterial pressure and clinical outcomes after noncardiac surgery：toward an empirical definition of hypotension. Anesthesiology 119：507-515, 2013
14) Berríos-Torres SI, Umscheid CA, Bratzler DW, et al.：Centers for Disease Control and Prevention Guideline for the Prevention of Surgical Site Infection, 2017. JAMA Surg 152：784-791, 2017
12) Greif R, Akça O, Horn E-P, et al.：Supplemental perioperative oxygen to reduce the incidence of surgical-wound infection. N Engl J Med 342：161-167, 2000
10) Benes J, Giglio M, Brienza N, et al.：The effects of goal-directed fluid therapy based on dynamic parameters on post-surgical outcome：a meta-analysis of randomized controlled trials. Crit Care 18：584, 2014
11) He B, Xu B, Xu X, et al.：Hydroxyethyl starch versus other fluids for non-septic patients in the intensive care unit：a meta-analysis of randomized controlled trials. Crit Care 19：92, 2015
5) Feldheiser A, Aziz O, Baldini G, et al.：Enhanced Recovery After Surgery（ERAS）for gastrointestinal surgery, part 2：consensus statement for anaesthesia practice. Acta Anaesthesiol Scand 60：289-334, 2016
32) Devlin JW, Skrobik Y, Gélinas C, et al.：Clinical Practice Guidelines for the Prevention and Management of Pain, Agitation/Sedation, Delirium, Immobility, and Sleep Disruption in Adult Patients in the ICU. Crit Care Med 46：e825-e873, 2018
30) Lorente L, Lecuona M, Jiménez A, et al.：Influence of an endotracheal tube with polyurethane cuff and subglottic secretion drainage on pneumonia. Am J Respir Crit Care Med 176：1079-1083, 2007
References_xml – reference: 18) Meyhoff CS, Jorgensen LN, Wetterslev J, et al.：Increased long-term mortality after a high perioperative inspiratory oxygen fraction during abdominal surgery：follow-up of a randomized clinical trial. Anesth Analg 115：849-854, 2012
– reference: 33) 日本版・集中治療室における成人重症患者に対する痛み・不穏・せん妄管理のための臨床ガイドライン〈https://www.jsicm.org/pdf/2015-J-PAD-guideline.pdf〉（2021.3.27閲覧）
– reference: 6) Wuethrich PY, Burkhard FC, Thalmann GN, et al.：Restrictive deferred hydration combined with preemptive norepinephrine infusion during radical cystectomy reduces postoperative complications and hospitalization time：a randomized clinical trial. Anesthesiology 120：365-377, 2014
– reference: 22) Jaber S, Chanques G, Matecki S, et al.：Post-extubation stridor in intensive care unit patients. Risk factors evaluation and importance of the cuff-leak test. Intensive Care Med 29：69-74, 2003
– reference: 28) 人工呼吸関連肺炎予防バンドル　2010改訂版〈https://www.jsicm.org/pdf/2010VAP.pdf〉（2021.3.27閲覧）
– reference: 5) Feldheiser A, Aziz O, Baldini G, et al.：Enhanced Recovery After Surgery（ERAS）for gastrointestinal surgery, part 2：consensus statement for anaesthesia practice. Acta Anaesthesiol Scand 60：289-334, 2016
– reference: 16) Reinhart K, Bloos F, König F, et al.：Reversible decrease of oxygen consumption by hyperoxia. Chest 99：690-694, 1991
– reference: 20) Volk T, Peters J, Sessler DI：The WHO recommendation for 80％ perioperative oxygen is poorly justified. Anaesthesist 66：227-229, 2017
– reference: 26) Cook DJ, Walter SD, Cook RJ, et al：Incidence of and risk factors for ventilator-associated pneumonia in critically ill patients. Ann Intern Med 129：433-440, 1998
– reference: 30) Lorente L, Lecuona M, Jiménez A, et al.：Influence of an endotracheal tube with polyurethane cuff and subglottic secretion drainage on pneumonia. Am J Respir Crit Care Med 176：1079-1083, 2007
– reference: 4) Nisanevich V, Felsenstein I, Almogy G, et al.：Effect of intraoperative fluid management on outcome after intraabdominal surgery. Anesthesiology 103：25-32, 2005
– reference: 25) Kuriyama A, Umakoshi N, Sun R：Prophylactic Corticosteroids for Prevention of Postextubation Stridor and Reintubation in Adults：A Systematic Review and Meta-analysis. Chest 151：1002-1010, 2017
– reference: 1) CoBaTrICE：Competency-Based Training in Intensive Care Medicine in Europe.〈http://www.cobatrice.org/en/index.asp〉（2021.3.27閲覧）
– reference: 11) He B, Xu B, Xu X, et al.：Hydroxyethyl starch versus other fluids for non-septic patients in the intensive care unit：a meta-analysis of randomized controlled trials. Crit Care 19：92, 2015
– reference: 7) Walsh M, Devereaux PJ, Garg AX, et al.：Relationship between intraoperative mean arterial pressure and clinical outcomes after noncardiac surgery：toward an empirical definition of hypotension. Anesthesiology 119：507-515, 2013
– reference: 12) Greif R, Akça O, Horn E-P, et al.：Supplemental perioperative oxygen to reduce the incidence of surgical-wound infection. N Engl J Med 342：161-167, 2000
– reference: 13) Allegranzi B, Zayed B, Bischoff P, et al.：New WHO recommendations on intraoperative and postoperative measures for surgical site infection prevention：an evidence-based global perspective. Lancet Infect Dis 16：e288-e303, 2016
– reference: 10) Benes J, Giglio M, Brienza N, et al.：The effects of goal-directed fluid therapy based on dynamic parameters on post-surgical outcome：a meta-analysis of randomized controlled trials. Crit Care 18：584, 2014
– reference: 8) Calvo-Vecino JM, Ripollés-Melchor J, Mythen MG, et al.：Effect of goal-directed haemodynamic therapy on postoperative complications in low-moderate risk surgical patients：a multicentre randomised controlled trial（FEDORA trial）. Br J Anaesth 120：734-744, 2018
– reference: 31) Bouza E, Jesús Pérez M, Muñoz P, et al.：Continuous aspiration of subglottic secretions in the prevention of ventilator-associated pneumonia in the postoperative period of major heart surgery. Chest 134：938-946, 2008
– reference: 15) Barbateskovic M, Schjørring OL, Russo Krauss S, et al.：Higher versus lower fraction of inspired oxygen or targets of arterial oxygenation for adults admitted to the intensive care unit. Cochrane Database Syst Rev 2019：CD012631, 2019
– reference: 32) Devlin JW, Skrobik Y, Gélinas C, et al.：Clinical Practice Guidelines for the Prevention and Management of Pain, Agitation/Sedation, Delirium, Immobility, and Sleep Disruption in Adult Patients in the ICU. Crit Care Med 46：e825-e873, 2018
– reference: 29) Lorente L, Blot S, Rello J：New issues and controversies in the prevention of ventilator-associated pneumonia. Am J Respir Crit Care Med 182：870-876, 2010
– reference: 27) Safdar N, Dezfulian C, Collard HR, et al.：Clinical and economic consequences of ventilator-associated pneumonia：a systematic review. Crit Care Med 33：2184-2193, 2005
– reference: 14) Berríos-Torres SI, Umscheid CA, Bratzler DW, et al.：Centers for Disease Control and Prevention Guideline for the Prevention of Surgical Site Infection, 2017. JAMA Surg 152：784-791, 2017
– reference: 21) François B, Bellissant E, Gissot V, et al.：12-h pretreatment with methylprednisolone versus placebo for prevention of postextubation laryngeal oedema：a randomised double-blind trial. Lancet 369：1083-1089, 2007
– reference: 9) Michard F：Changes in arterial pressure during mechanical ventilation. Anesthesiology 103：419-428, 2005
– reference: 24) Miller RL, Cole RP：Association between reduced cuff leak volume and postextubation stridor. Chest 110：1035-1040, 1996
– reference: 3) Lobo DN, Bostock KA, Neal KR, et al.：Effect of salt and water balance on recovery of gastrointestinal function after elective colonic resection：a randomised controlled trial. Lancet 359：1812-1818, 2002
– reference: 23) Wittekamp BHJ, van Mook WNKA, Tjan DHT, et al.：Clinical review：post-extubation laryngeal edema and extubation failure in critically ill adult patients. Crit Care 13：233, 2009
– reference: 17) Meyhoff CS, Wetterslev J, Jorgensen LN, et al.：Effect of high perioperative oxygen fraction on surgical site infection and pulmonary complications after abdominal surgery：the PROXI randomized clinical trial. JAMA 302：1543-1550, 2009
– reference: 19) Kurz A, Fleischmann E, Sessler DI, et al.：Effects of supplemental oxygen and dexamethasone on surgical site infection：a factorial randomized trial. Br J Anaesth 115：434-443, 2015
– reference: 2) Chappell D, Jacob M, Hofmann-Kiefer K, et al.：Antithrombin reduces shedding of the endothelial glycocalyx following ischaemia/reperfusion. Cardiovasc Res 83：388-396, 2009
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[要旨] 「ICUで術後を診るようになって, 麻酔も上手くなった」. これは私が所属する横浜市大で, 数カ月のICU研修を終えた若手からよく聞く言葉である. 術後ICUで患者を診る側に立って, 最適な麻酔管理を考える. 逆に手術中の麻酔科医の立場から, ICUに適切な術後管理を提案する....
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StartPage 388
SubjectTerms 双方向性
周術期管理
集中治療
麻酔
Title ICUで術後を診て，麻酔も上手くなろう
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